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How do prior authorization delays drive up patient out of pocket costs?

Running a small healthcare practice, I quickly realized that getting prior authorizations (PAs) approved for medications was one of the biggest operational headaches we faced. Most approvals took a few days, but sometimes it stretched into weeks, especially with complex drugs or incomplete paperwork. The delays frustrated our patients and overwhelmed our staff, who were already stretched thin trying to keep up with clinical care and insurance requirements.

Prior authorization is basically the insurance company’s way of making sure a prescribed medication is medically necessary and fits their coverage rules before the patient gets it. This process is especially common for expensive brand-name drugs, off-label uses, or medications that require trying cheaper alternatives first. If the PA isn’t approved in time, patients either face treatment delays or are forced to pay out-of-pocket—neither of which we wanted.

Why Prior Authorization Was Such a Burden for Us?

The process felt like a bottleneck. Missing or incomplete documentation was a common reason for delays. Sometimes our team faxed requests that got lost or took forever to reach the right department. Every delay meant anxious patients, extra phone calls, and more work for us to follow up.

In some cases, prior authorizations took 5–10 business days or longer, especially for specialty drugs. Even urgent requests weren’t always fast enough. It was clear our manual process wasn’t working, and that was impacting patient care and clinic revenue.

How Staffingly Helps with Prior Authorization?

When we partnered with Staffingly, everything changed. Here’s how their support helped us transform the PA process:

• Specialized Virtual Teams: Staffingly assigned us healthcare-trained prior authorization specialists who know exactly what insurance companies require no more guesswork or trial and error.

• Electronic Prior Authorization (ePA) Integration: They set up and managed digital PA submissions through ePA platforms integrated with our EHR, which drastically cut down manual errors and processing time.

• Complete Documentation Preparation: Their experts ensure all necessary clinical notes, lab results, and patient history are included upfront, reducing denials and requests for more info.

• Proactive Follow-Up: Staffingly continuously monitors every authorization request, promptly following up with payers and escalating urgent cases to prevent unnecessary delays.

• Denial Management & Appeals: If a PA is denied, their team helps prepare appeals with detailed clinical evidence and facilitates peer-to-peer reviews with insurance medical directors.

Benefits of Efficient Prior Authorization

With Staffingly’s help, we saw these key benefits:

• Faster Medication Access: Most medication prior authorizations now clear within 1 to 3 business days, ensuring patients start treatment sooner.

• Reduced Administrative Burden: Our staff was freed from chasing paperwork and phone calls, letting them focus on patient care and other priorities.

• Lower Denial Rates: Comprehensive and accurate PA submissions meant fewer denials and rework.

• Improved Patient Satisfaction: Patients experienced less waiting and frustration, boosting trust and loyalty.

• Revenue Protection: Timely approvals helped us avoid lost claims and out-of-pocket patient payments, stabilizing our cash flow.

Why Outsourcing Prior Authorization Makes Sense for Small Practices?

Handling prior authorizations internally is complicated and time-consuming, especially when insurance policies frequently change. With Staffingly’s healthcare-specific digital outsourcing, small and mid-sized practices can:

• Access trained specialists without the cost of hiring full-time staff

• Streamline processes with modern ePA technology

• Scale support up or down based on patient volume

• Maintain full HIPAA compliance and data security

• Keep their focus on delivering excellent clinical care

What to Do If a Prior Authorization Is Denied?

Even with outsourcing, denials can happen. Staffingly helps by reviewing the denial reasons, preparing a thorough appeal with supporting documentation, and coordinating direct peer-to-peer discussions with insurance reviewers. Their expertise has turned many denials into approvals faster than we could manage alone.

What Did We Learn?

Prior authorization doesn’t have to be a roadblock. With digital healthcare outsourcing through Staffingly, small practices like ours can drastically reduce approval times, cut down administrative burdens, and improve patient outcomes. If your clinic struggles with PA delays and paperwork overload, partnering with Staffingly is a game-changer.

What People Are Asking?

Q: What is prior authorization for medication?
A: It’s insurance approval required before certain meds can be prescribed to ensure medical necessity.

Q: Why does prior authorization cause delays?
A: Due to incomplete forms, missing docs, manual submissions, and complex payer rules.

Q: How long does prior authorization usually take?
A: Typically 1–3 business days, but can extend to 5–10 days or more for complex cases.

Q: How does Staffingly help with prior authorization?
A: Staffingly provides trained specialists, ePA integration, documentation prep, and continuous follow-up.

Q: What benefits come from outsourcing prior authorization to Staffingly?
A: Faster approvals, fewer denials, reduced admin work, improved patient satisfaction, and better revenue flow.

Disclaimer

For informational purposes only; not applicable to specific situations.

For tailored support and professional services,

Please contact Staffingly, Inc. at (800) 489-5877

Email : support@staffingly.com.

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