Problems with prior authorization, utilizing health insurance coverage are prevalent, survey finds

Editor's Note

This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials. 

According to the survey, titled "KFF Survey of Consumer Experiences with Health Insurance":

• 16% of all insured adults in the past year experienced prior authorization problems
• adults insured under Medicaid (22%) were more likely than those insured by Medicare (11%) or those with employer-sponsored coverage (15%) to experience prior authorization problems
• adults who used more health services and had more than 10 physician visits in the past year were more likely to experience prior authorization problems (31%) than those with three to 10 visits (20%) and two or fewer visits (10%).
• insured adults who sought help or took prescriptions for mental health conditions like depression or anxiety (26%) were more likely than those who did not (13%) to experience prior authorization problems. 

If consumers experienced prior authorization problems, the survey found that they were also much more likely to have experienced other problems using their coverage, including reaching the limit on covered services, having their claims denied, and inability to access an in-network provider.