For Immediate Release:
November 9, 2021
Media Contact:
Karissa Hand
Cell: 508-406-8186
Consumers, Advocates and Legislators Urge Simplification of Health Plan Prior Authorization Process

H 1200/S 637 would lower administrative barriers consumers and providers face when accessing or delivering health care

BOSTON – Consumers, advocates and legislators on Tuesday testified to the Joint Committee on Financial Services in support of An Act to improve the Health Insurance Prior Authorization Process (H 1200 / S 637). The bill, which is sponsored by Senator Jo Comerford and Representative Jon Santiago, will simplify the prior authorization, or pre-approval, process to lower the administrative barriers that consumers and providers often face when trying to access or deliver health services and medications, especially for chronic conditions.

“Just because a consumer has a health insurance card in hand, doesn’t mean that they always have access to timely, quality and affordable care. Health insurance coverage is not the only barrier to care that Massachusetts residents face – they also have to jump through administrative hoops to obtain the care and medications they need,” said Hannah Frigand, Director of Education and Enrollment Services for Health Care For All. “This is especially prevalent for individuals with chronic conditions, which disproportionately impact People of Color. The Massachusetts legislature can lower barriers to care and advance health equity by passing H 1200/S 637 this session.”

“When I first developed an uncommon autoimmune neurological disorder that profoundly affects my autonomic functions, cognition, body tissues and even hormones, my neurologist told me that the best known treatment was immunotherapy. I didn’t realize that it was only FDA approved to treat a handful of conditions, not including mine,” said Melissa Bridges, a Brookline resident who contacted Health Care For All’s partner organization Health Law Advocates. “After my doctor submitted prior authorization for this treatment, I waited for three months while my health rapidly deteriorated. If the prior authorization process had been faster and clearer, I’d have started treatment sooner and prevented my condition from deteriorating to such a severe place that I required hospitalization. I would not have sustained such damage to my nerve function, tissues and cognitive function, nor endured such pain and suffering and incredible disability.”

Specifically, the bill would reform the health plan prior authorization process by prohibiting plans from modifying or rescinding prior authorizations issued unless inaccurate information is provided and by improving transparency about prior authorization policies in communications to providers and consumers. It would also create a committee, chaired by the Division of Insurance, to develop recommendations related to prior authorization and require the Health Policy Commission to issue a report on the progress of adoption of statewide standard forms.

“Far too often, consumers and providers face difficulties when trying to obtain the prior authorization required for a health service or medication,” said Senator Jo Comerford. “This slows down the process for the delivery of care and adds a significant burden to what is often already a stressful situation. We must pass S 637 to ensure that every Massachusetts resident can receive the care they need in a timely manner.”

“I’ve treated too many ER patients who came in sick because their insurance coverage delayed necessary medications and treatment,” said Representative Jon Santiago. “Delayed care can be deadly and it is why we must pass H 1200.”