Overwhelming Confusion Around Prior Authorizations and Pricing Information Points to Need for Streamlined Solutions

December 19, 2024


• Categories: 01-Digital Health, Patient Engagement, Policy, Reimbursement, Revenue Cycle Management, Topic – Digital Healthcare Intelligence

Press Release: MTI Staff was not involved in writing this content

---

VIENNA, VA. (December 18, 2024) — careviso announced today the findings of its latest industry survey exploring the impact of communication gaps and financial transparency on patient experiences. The results reveal significant confusion and miscommunication within the healthcare system, leaving patients struggling to navigate a complex environment.

The online survey, which reached diverse patients across the United States during November 2024, found that over 80% of patients reported experiencing confusion or miscommunication between healthcare providers and insurance companies regarding prior authorizations at least sometimes. Adding to the challenges, only about 19% of patients indicated they are usually or always aware of coverage details and costs before undergoing medical procedures. This lack of transparency leaves patients uncertain about their financial responsibilities and leads to missed opportunities for cost-effective care planning.

Additionally, the survey revealed a growing demand for a more patient-friendly approach to financial transparency. Nearly 80% of respondents said they would prefer to receive pricing and authorization information from a third-party service or a combination of their doctor and health insurance, rather than relying on either party alone.

When patients attempt to seek information about pricing or prior authorization status, they often face additional uncertainty about who to contact first. Approximately 20% reach out to their healthcare provider, 30% contact their insurance plan, and nearly 30% don’t know where to obtain this information. These findings underscore the urgent need for a more streamlined, patient-centered approach to healthcare communication.

In a previous survey, careviso highlighted how prior authorization delays lead to over 80% of patients forgoing medical care due to confusion about pricing or insurance coverage. Together, these findings demonstrate the pressing need for systemic improvements in healthcare communication and transparency.

These challenges echo growing calls from organizations like the American Medical Association (AMA) for comprehensive prior authorization reform. The AMA has emphasized that legislative action is critical to reducing administrative burdens and improving patient access to timely care. Initiatives such as the AMA’s advocacy for congressional reform align with careviso’s mission to address these systemic inefficiencies through technology and innovation.

“As patients continue to bear the brunt of inefficiencies in the healthcare system, it’s clear that better communication and financial transparency are necessary,” said Brandon Blais, Chief Technology Officer of careviso. “Addressing these challenges by providing technology solutions [can] make it easier for patients, providers, and payors to access the information they need, when they need it.”