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Opinion: Prior Authorization Imposes Unnecessary Barriers to Prenatal and Maternal Care

The COVID-19 pandemic has disproportionately impacted communities of color, shining a light on the stark inequities that exist in our country’s healthcare system. And while we may be turning a corner from the darkest days of pandemic, we must continue to uproot the systemic discrimination that remains in the healthcare system beyond COVID-19.

In particular, I’ve heard from so many women who have expressed to me the barriers that they continue to face when trying to access the safest and highest quality prenatal and maternal care.

One of the most significant barriers to accessing the best prenatal and maternal care are prohibitive prior authorization requirements instituted by some private insurance companies. These policies require physicians and providers to get permission before providing specific prenatal and maternal care services for expecting mothers, such as prenatal genetic tests.

While insurers argue that these policies are intended to ensure that services and procedures are performed under appropriate clinical conditions, the reality is that these policies have imposed unnecessary barriers to critical, timely care for pregnant women.

Take, for example, access to non-invasive prenatal testing, or NIPT. Leading medical groups like ACOG, the American College of Obstetricians and Gynecologists, recently endorsed NIPT as the most accurate screening test for common chromosomal disorders and subsequently updated its guidelines to recommend NIPT for all pregnancies, regardless of risk.

Most major health insurance companies now universally cover NIPT for all expectant mothers, but some—including the nation’s largest insurer, UnitedHealthcare—still require preauthorization before a woman can actually receive access to NIPT.

As ACOG has stated, preauthorization “requirements place additional burdens on physicians and their staff, negatively impacting access to genetic testing.” A 2020 American Medical Association physician survey found that 94% of expert respondents agreed that preauthorization requirements delay their patients’ access to necessary care, and 79% agreed this can sometimes lead to abandoning treatment.

These access delays deepen the current disparities in access to quality care, rather than uprooting them. And we know that large disparities already exist in access to superior testing options like NIPT, disproportionately impacting mothers of color.

In fact, data from the California Department of Public Health found that white women who opted out of California’s state-funded prenatal screening program, which only provides NIPT as a second-tier testing option, were more than twice as likely to gain access to NIPT as Black women — 39% to 17%.

The good news is that most larger insurance companies—including Aetna, Cigna, Anthem, and Humana—have either recently eliminated or never required prior authorization for access to NIPT. This leaves UnitedHealthcare as the lone holdout among major insurers, continuing to cause delays to serving patients while deepening the disparities that remain in our healthcare system.

All women—regardless of race, ethnicity, geography, or socioeconomic background—deserve equitable access to the best prenatal and maternal care options. That work can continue through removing preauthorization requirements for NIPT.

Brianna Wetherbe is a board member at Stand Up for APA and a San-Diego based women’s health advocate focused on bringing equitable prenatal and maternal health care to all women.

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