A coalition of health insurance companies promises to make changes to the prior authorization process, after years of complaints from patients and providers about a system that, according to them, slows care and endangers the health of people.
On Monday, federal health officials met representatives of some of the most important insurance companies in the country, including Aetna, Blue Cross Blue Shield Association, Cigna, Kaiser Permanent and UnitedHealthcare. The coalition of insurers voluntarily promised to streamline the widely criticized process.
The insurance companies, as well as secretary Robert F. Kennedy Jr. From health and human services and centers for Medicare & Medicaid Services manager Dr. ir. Mehmet Oz, the commitment considered a step towards improving the country’s health care system.
But this is not the first time that insurers have promised to reform the process in recent years, because it has received fierce criticism.
This is what about prior authorization and what insurers have sworn to do.
What is prior authorization?
Previous authorization refers to when medical care providers should receive approval from insurers before they perform a service.
Why is it so controversial?
Patients and providers have criticized insurance companies for refusing prior authorization requests, and say that it prevents or slows down that patients have access to care that is recommended by their doctors.
Almost one in three doctors reports that applications for earlier authorization are often or always refused, and about 75% said that the number of denials has increased somewhat or considerably in the last five years, according to a 2024 questionnaire Led by the American Medical Association. About 93% of the doctors reported that prior authorization delayed access to the necessary care and 82% said that the process, at least sometimes, can lead to patients who leave the treatment completely, the survey showed. More than one in four doctors who responded to the survey reported that the process led to serious side effects for a patient who treated them.
Read more: What to do if a health insurance policy denies the care that you really need
The fatal shooting in December of the Brian Thompson, CEO of UnitedHealthcare, which was on its way to an investor meeting in New York at the time of the attack, achieved national headlines and attracted renewed attention to the prior authorization controversies.
Oz said During a press conference there was “violence on the street about these issues” in a clear reference to the shooting.
“This is no longer a passively accepted reality – Americans are upset,” said Oz.
Insurers have promised to reform the process earlier
Health insurance companies have made similar promises to renew prior permission in the past – in both 2018 And 2023Some insurers promised to improve the process. But experts criticized The companies for not making substantial changes.
UnitedHealthCare has said That this year will reduce the total number of services that prior authorization requires almost 10%.
In February, Cigna involved To make a number of changes to the process, such as announcing plans to invest in resources that would help more patients to resolve problems with prior authorization faster, and to streamline the process for doctors to submit requests.
What do they commit to do now?
By one press release From the Ministry of Health and Human Services (HHS), the Coalition of Health Securers is committed to six reforms on Monday:
- Standardize electronic entries for earlier permission
- Reduce the number of medical services required on January 1, 2026
- Honor existing authorizations while patients switch to another insurance plan to ensure that continuous care is uninterrupted
- Improving transparency and communication with regard to authorization decisions and appeals
- Delays of delays by expanding real -time approvals for most requests by 2027
- Ensure that medical professionals assess all denials on clinical care and services
What say RFK Jr. and Dr. Oz?
Kennedy thanked the insurers who promised to spend reforms.
“Americans should not negotiate with their insurer to get the care they need,” he said in the press release. “Puts of patients and their doctors against solid companies was not good for everyone. We actively work with the industry to make it easier to get prior authorization for common services such as diagnostic imaging, physiotherapy and outpatient surgery.”
OZ noted that the increasing negative feelings of Americans are increasing negative feelings, OZ said in a press release from HHS that the dedication of insurance companies “was a step in the right direction to restore trust, to alleviate the burden for providers and help patients to receive timely, evidence-based care.”
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