ASNC at AMA: Stop Insurers from Denying Payment After Prior Authorization

At the November 2024 American Medical Association (AMA) Interim House of Delegates (HOD) meeting, ASNC voted in favor of a resolution aimed at requiring insurers to pay for all preauthorized services, including those approved as part of a health plan’s “gold card” program. The resolution passed.

Introduced by the New York delegation, Resolution 818 states that the AMA will support legislation or regulations prohibiting insurers from backing out of paying, or seeking to recoup payment, for tests or procedures that were previously approved via prior authorization.

Introduced by the New York delegation, Resolution 818 states that the AMA will support legislation or regulations prohibiting insurers from backing out of paying, or seeking to recoup payment, for tests or procedures that were previously approved via prior authorization.

At the HOD Reference Committee, there was discussion of disruptions from retrospective denial of payments despite prior authorization, with the payers justifying their actions by citing overpayment, redetermination of medical necessity, or incomplete paperwork.

“We know that ASNC members face a great deal of administrative hassle with prior authorization requests,” says Suman Tandon, MD, FASNC, who is ASNC’s delegate to the AMA HOD. “The last thing they need is additional issues with payment after they have successfully completed prior authorization.”

ASNC advocacy priorities include opposing prior authorization requirements that delay patients’ access to timely care.

ASNC’s Policy Priorities