State and federal governments are considering and implementing proposals to reform ... [ ] prior-authorization practices.

You have worked for your company for 15 years. You suffer from chronic back pain. Your company provides you with what you objectively believe to be good health insurance. You have tried all sorts of physical therapy and injections. Eventually you and your doctor decide, together, surgery is the last, best and only option. Then, your insurance company refuses to pay for it.

That is a frustrating problem, and it’s a common one, but the government is starting to take notice — and action. State and federal governments are considering and implementing proposals to reform the system.

Prior authorization is a tactic used by insurance companies to reduce costs of what they believe to be potentially unnecessary treatments. Before they agree to pay for certain medicines, diagnostic tests or surgeries, the insurance company must pre-approve it. This often culminates in a “peer-to-peer” discussion between the physician team lobbying for the procedure on behalf of the patient and a representative of the insurance company arguing against the procedure.

At face value, this makes sense, but the injection of the insurance company in between the patient and the doctor causes problems.

As many as 94% of physicians said prior authorization delayed care for........

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