Large health insurance companies vowed to cut down on use of a common tool to vet requests before letting doctors bill for medical services or prescriptions.
UnitedHealthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente, Humana and other health insurance companies on June 23 announced plans to “streamline, simplify and reduce prior authorizations.” Doctors and patients have long criticized prior authorizations, saying in surveys and government oversight reports the practice routinely delays or denies care.
The changes to prior authorization will be phased in over the next year and a half, the companies said. In all, insurers said the changes would apply to 257 million Americans covered by private commercial insurance, Medicare Advantage and Medicaid managed care plans.
Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz were scheduled to discuss the insurance reforms during a Monday news conference in Washington, D.C.
Under prior authorization, doctors or hospitals must ask a patient’s health insurance company before care such as an operation or prescribing certain prescription drugs. Doctors complain the process is burdensome and it’s often used to delay or deny medically necessary medical care for patients. Insurance companies counter that authorizations are a vital tool to prevent unnecessary tests and medical care that inflates medical bills for families.
During his confirmation hearing in March, Oz said prior authorizations were “misused in some cases” by private Medicare plans and needed to be addressed. He suggested a list of services with clear descriptions in which private Medicare plans could use preauthorization.
Nearly 1 in 5 adults with health insurance said they experienced a prior authorization problem in the past year, according to a 2023 survey from KFF, a health policy nonprofit.
The health insurers vowed changes will bring faster access for patients and fewer challenges, according to a statement shared by America’s Health Insurance Plans, a trade group.
The group said health insurers would “reduce the scope of claims” subject to prior authorization. Insurers also said they would implement measures to ensure continuity of care when patients switched insurance plans and give clearer explanations on decisions.
In a statement, AHIP President and CEO Mike Tuffin said the health plans are “making voluntary commitments to deliver a more seamless patient experience” and allowing doctors to focus on patient care.
This article originally appeared on USA TODAY: Health insurance companies vow changes to prior authorization
