Prior authorization is a review that insurance companies will check before they agree to pay for certain health services or medications. Sometimes called precertification or prior approval, this process requires physicians and other health care providers to obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. We support efforts to protect consumers by increasing transparency in this process.
Current Georgia Legislation: Senator Kay Kirkpatrick (R-32) introduced Senate Bill 80, known as the Ensuring Transparency in Prior Authorization Act, which aims to address barriers to care created by prior authorization. SB 80 requires that insurers make any requirements or restrictions for prior authorization available on its website to the general public. This publicly available information must include, all written clinical criteria. Additionally, the bill sets guidelines and time tables for prior authorization that ease the burden of prior authorization on patients and health care providers. This bill crossed over on March 1, 2021.