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news
September 25, 2024
A precarious waiting game: Prior authorization and patient care
By DR. EDGAR ?BUD? BOYD PRESIDENT OF THE OKLAHOMA STATE MEDICAL ASSOCIATION

“Prior authorization.” Largely unknown until a few years ago, it’s quickly become one of those insurance terms that’s sure to give any medical provider or patient an instant headache.

Insurance companies require prior authorization for certain procedures, tests and medications. In order to approve treatment, the insurance company puts a hold on a claim while it is reviewed on its end before an approval or a denial is issued. This process was implemented to keep costs down and limit egregious claim approvals, all to the benefit of the insurance company.

As our system stands, insurance companies are a necessary part of our health care model, but at the end of the day, they’re for-profit entities. Their cost-saving measures tend to outweigh what’s best for patients, and that’s when problems arise. Unfortunately, it’s happening all too often.

As a physician, I can attest that prior authorization has been a pain point for me—and, more importantly, for my patients—for many years. Which treatments require prior authorization isn’t always clearly spelled out, leaving physicians and patients to navigate a minefield of authorization-related delays and denials. Physicians and staff routinely spend hours on administrative tasks related to prior authorization, like submitting documents and following up on approvals, spending precious patient time listening to the insurance companies’ hold music. It’s frustrating and can be dangerous as delays for patients with time-sensitive treatment plans can be life threatening.

Now, AI has crept into the prior authorization process. Patients have long been denied access to medical care as a result of prior authorization reviews, but these days, a computer may be issuing the denial. There’s not even a human involved in the process, much less a doctor. This is unacceptable.

The tide is turning, but there’s still much work to be done: Prior authorization has been recognized as an issue by lawmakers, and in May of this year, the Ensuring Transparency in Prior Authorization Act was signed into law. When it goes into effect in 2025, the law will establish more stringent and transparent timeframes and policies for prior authorizations. Insurance companies will be required to modernize their authorization systems, publish prior authorization requirements online and require licensed medical professionals to make denials, just to name a few.

This is a win for all Oklahomans. It ensures patients receive timely, appropriate treatment, as determined by medical professionals. Plus, it allows physicians— many of whom are already stretched thin, especially in rural areas—to spend more time treating patients and less time on administrative runaround.

At the end of the day, our patients trust medical professionals with their lives, not insurance companies. Red tape has no place in health care.

Edgar Morris Boyd, M.D. is an otolaryngologist in Muskogee, where he practices at the Warren Clinic Saint Francis Health System. He is president of the Oklahoma State Medical Association.

Battle of Honey Springs still making history
A: Main, news
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By LaDonna Rhodes Staff Writer 
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The Battle of Honey Springs Reenactment drew sizable crowds as did Education Day as actors and staff made history come to life over the threeday weekend of events from Nov. 7-9. Visitors and students ...
A: Main, news
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The Main Street project (SH 9) by the Oklahoma Department of Transportation in Eufaula is expected to continue through the first week in December. An ODOT spokesman said the downtown section of the pr...
A: Main, news
Annual Local Flavor event on Nov 18
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Under One Roof is pleased to announce the return of its highly anticipated annual fundraising event, Local Flavor, to be held on Tuesday, November 18, from 6 p.m. – 8:30 p.m. at The Sandbar Tavern, 24...
A: Main, news
Superintendent Guthrie announces retirement
By JERRY FINK MANAGING EDITOR 
November 12, 2025
Eufaula School Superintendent Monty Guthrie announced at Monday’s School Board meeting that he is retiring effective June 30, 2026, the final day of this school year. He stated he will finish his care...
A: Main, news
EIC hosting garage sale
November 12, 2025
The Eufaula Indian Community Elder Group is hosting an inside Community Garage Sale on Saturday, Nov. 15, 9 a.m. to 3 p.m. The sale will be held at the Eufaula Indian Community Center, 800 Birkes Road...
A: Main, news
Watts Mural to be dedicated
November 12, 2025
Vision Eufaula invites everyone to the dedication of the JC Watts Mural on Monday, Nov. 17, at noon at City Hall. The mural was created during Vision’s 2024 Wine & Art Festival as a Paint By Numbers c...
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