Insurance Authorization Requirements Delay Care for Child, Adolescent Psychiatric Patients

A study in the American Journal of Emergency Medicine suggests child and adolescent psychiatric patients in need of immediate hospital admission often wait an hour before the admission authorizations required by insurance companies are approved. According to the authors, such delays put a significant burden on psychiatric clinicians and can create safety risks.

For this analysis, licensed social workers at Rhode Island’s Hasbro Children’s Hospital emergency room completed paperwork each time they contacted an insurance company on behalf of a child deemed in need of psychiatric admission.

Over a five-month period, 203 requests for psychiatric admission authorization of youth aged 4 to 19 took place. The most common reasons for admission included suicidal ideation or a suicide attempt, aggression, and homicidal ideation. The average time required to obtain insurance authorization was 59.8 minutes (overall times ranged from 3 minutes to 270 minutes). While there were variations in time required for authorization based on insurance type, all 203 requests for authorization were granted.

“Given that 100% of our attempts to obtain authorization were granted, the need to obtain prior authorizations appears to function more as an administrative hurdle rather than an effective triage to deny care, because if professionals know they or their colleagues are going to have to spend lengthy amounts of time on the phone with the insurance company, they may think twice prior to trying to admit a given patient,” the authors wrote.

“Insurance reviews and pre-authorization requests are just a part of what makes accessing needed psychiatric care difficult for children and adolescents… Adding prior authorization to an already difficult process, especially for psychiatric patients who are deemed to be of ‘imminent risk’ to themselves or others, seems both dangerous and predatory,” they concluded.

For related information, see the Psychiatric News article “Emergency Department Finds Successful Formula for Psychiatric Cases.”

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Insurers Delay Hospitalization of Severely Ill Psychiatric Patients

Hospitalization of severely ill psychiatric patients can be delayed because of authorization required by insurance companies, a study reported in the Annals of Emergency Medicine has found. The study was headed by Amy Funkenstein, M.D., a child psychiatry fellow at Brown University, and J. Wesley Boyd, M.D., an assistant clinical professor of psychiatry at Harvard Medical School. (Funkenstein and her colleagues conducted the study while she was a psychiatry resident at Harvard Medical School.) The study included 53 severely ill psychiatric patients in the Cambridge Health Alliance Psychiatric Emergency Department. Psychiatry residents tending to the patients averaged 38 minutes from the time of first contact with an insurance company until authorization to hospitalize the patients was either granted or denied. Although half the authorization requests took less than 20 minutes to be approved, for about 10 percent of patients authorization requests took an hour or more, with the longest request taking five hours.

"Private insurers are obstructing care by requiring authorizations before a qualified psychiatrist can hospitalize a dangerously ill patient," Boyd said in a press statement. "With doctors, nurses, and emergency departments already overburdened, adding a time-consuming bureaucratic task that doesn't help patients is unconscionable."

To read more about the challenges that emergency psychiatrists face in their work, see Psychiatric News here and here. Also see Clinical Manual of Emergency Psychiatry, from American Psychiatric Publishing.

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