Health Insurers Vow—Again—to Fix Prior Authorization Process
A coalition of health insurance companies promises to modify the previous authorization process, after years of patients and complaints of providers concerning a system which, according to them, delays care and endangers people’s health.
On Monday, federal health officials met representatives of some of the country’s main insurance companies, notably Aetna, Blue Cross Blue Shield Association, Cigna, Kaiser Permanent and Unitedhealthcare. The coalition of insurers voluntarily undertook to rationalize the widely criticized process.
Insurance companies, as well as the Secretary of Health and Social Services Robert F. Kennedy Jr. and the Centers for Medicare & Medicaid Service Administrator, Dr. Mehmet Oz, presented the commitment as a step towards the improvement of the country’s health care system.
But this is not the first time that insurers have committed to reforming the process in recent years, because it has aroused violence.
Here is what to know about the prior authorization and what the insurers have sworn to do.
What is previous authorization?
The prior authorization refers to the time when medical suppliers must obtain approval of insurers before performing a service.
Why is it so controversial?
Patients and service providers criticized the insurance companies for denying previous authorization requests, saying that this prevents or delays patients from accessing the care recommended by their doctors.
Almost one in three doctor reports that previous authorization requests are frequently refused, and around 75% have said that the number of refusals has increased somewhat or significantly in the past five years, according to a survey in 2024 conducted by the American Medical Association. About 93% of doctors said the prior authorization had delayed access to the necessary care, and 82% said that the process can, at least sometimes, lead to the total abandonment of patients, revealed that the survey. More than one in four doctor who responded to the survey said that the process had led to a serious adverse event for a patient they treated.
Find out more: What to do when health insurance denies the care you really need
The deadly shooting in December of the United CEO of Unitedhealthcare, Brian Thompson, who was on his way to an investor meeting in New York at the time of the attack, made the headlines of national newspapers and drew renewed attention to the controversies surrounding the previous authorization.
Oz said at a press conference that there had been “violence in the streets on these questions”, in an apparent reference to the shooting.
“It is no longer something that is an accepted passive reality – the Americans are upset,” said Oz.
Insurers have promised to reform the process before
Health insurance companies have made similar promises to reorganize prior authorization in the past – in 2018 and 2023, some insurers have committed to improving the process. But experts criticized companies for not having made substantial changes.
Unitedhealthcare said that this year it will aim to reduce the total number of services requiring prior authorization by almost 10%.
In February, Cigna undertook to make a certain number of changes to the process, as announced by investment plans in resources that would help more patients solve problems with prior authorization, as well as to rationalize the process than doctors to submit requests.
What are they committed to doing now?
According to a press release from the Ministry of Health and Social Services (HHS), the coalition of health insurers is committed to six reforms on Monday:
- Standardize electronic prior authorization submissions
- Reduce the number of medical services that require prior authorization by January 1, 2026
- Honor existing authorizations while patients move to another insurance plan to ensure that continuous care is uninterrupted
- Improve transparency and communication concerning decisions and authorization calls
- Decrease delays by expanding real -time approvals for most requests by 2027
- Make sure that health professionals examine all refusals for clinical care and services
What do RFK Jr. and Dr Oz say?
Kennedy thanked insurers who have committed to reforms.
“Americans should not have to negotiate with their insurer to obtain the care they need,” he said in the press release. “The accounting of patients and their doctors to massive companies was not good for anyone. We actively work with the industry to facilitate prior authorization from common services such as diagnostic imaging, physiotherapy and ambulatory surgery. ”
Noting negative feelings of the Americans towards the process, Oz said in a press release from HHS that the commitment of insurance companies was “a step in the right direction towards restoration of confidence, the relaxation of charges on providers and help patients receive care based on timely evidence”.
