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Every day, Illinois hospitals provide lifesaving care. To provide that care, hospitals must overcome obstacles from Medicaid managed care organizations (MCOs), whose inappropriate denials of prior authorization requests harm patients. There are countless examples of MCOs overriding a physician’s medical determination and of the hurdles hospitals face in providing needed care. Here are a few:

• A rural southern Illinois Critical Access Hospital requested authorization for a patient to have an echocardiogram, a common test to detect heart conditions. The hospital’s credentialing specialist followed up 10 times and finally received approval 20 days later.

• A young child on dialysis was denied authorization for a kidney transplant listing and transplant, which unnecessarily delayed the child’s transplant listing for several weeks, with considerable time spent by the clinical team to appeal.

• Tests showed a patient with back pain had metastatic lesions throughout her body and an unusual appearance to one ovary. Her MCO wouldn’t approve imaging or an oncologist visit. Fearing for the patient’s health, the hospital’s oncology team committed to seeing the patient that week.

The Illinois Health and Hospital Association urges lawmakers to pass legislation addressing harmful prior authorization practices and eliminate barriers to healthcare for Illinois’ most vulnerable populations. Support IHA’s MCO prior authorization reforms.