Otolaryngology Practices Use Digital Tools to Pre-authorize—With Mixed Results

by Thomas R. Collins •

“I hope it certainly eases the burden and gives a message that not only applies to state regulatory plans in Texas but to all plans across all states and even federally to ease the prior authorization burden,” Dr. Holland said. The program went into effect on Oct. 1, 2023, and its effects are still taking shape and being assessed, he said.

Annette Pham, MD, a facial plastic surgeon and otolaryngologist in Rockville, Md., said she’s working with local county and state medical societies to establish a Gold Card program there as well. 

David Zeman, chief strategy officer for ENT and Allergy with clinics in New York and New Jersey, said practices should work with insurance companies to ease the process. “When you feel that their policies may be excessive, look to try to forge a relationship that allows you to influence a change in that policy,” he said.

Another worthy pursuit, said Dr. Pham, is to make requirements for prior authorization more transparent and readily available. “Avoiding a guessing game of what insurance companies are looking for would prevent physician frustrations with the system and hopefully also prevent burnout,” she said. 

The guidelines also need to be up to date with current evidence, she said. “Even if procedures involve use of newer medical devices, they may still be appropriately supported for use,” she said, and shouldn’t be automatically labeled as suspect or “experimental.”

Patients should also understand the burden of prior authorizations and the benefits of advocating for themselves. Her local Montgomery County Medical Society, for which she served as president in 2020, recently started the Patient Advocacy Network (http://www.montgomerymedicine.org/PAN) to strengthen the partnerships between physicians and patients.

“Our hope is to one day grow a large network of patients who can advocate for and effect positive changes for challenges such as prior authorization requirements,” she said. “This can be done by disseminating information through the large network and then having patients speak up to their legislators to enact these changes.”