U.S. insurers to vary approval process

Health plans under major U.S. insurers said Monday they’ve voluntarily agreed to hurry up and reduce prior authorizations – a process that is commonly a serious pain point for patients and providers when getting and administering care.

Prior authorization makes providers obtain approval from a patient’s insurance company before they perform specific services or treatments. Insurers say the method ensures patients receive medically needed care and allows them to manage costs. But patients and providers have slammed prior authorizations for, in some cases, resulting in care delays or denials and physician burnout.

Dozens of plans under large insurers akin to CVS Health, UnitedHealthcare, Cigna, Humana, Elevance Health and Blue Cross Blue Shield committed to a series of actions that aim to attach patients to care more quickly and reduce the executive burden on providers, in line with a release from AHIP, a trade group representing health plans. Though the businesses cheered the changes, they might cut into profits in the event that they result in patients using care more often.

“The American health care system must work higher for people, and we are going to improve it in distinctive ways that really matter,” said Steve Nelson, president of CVS’ insurer, Aetna, in a press release. “We support the industry’s commitments to streamline, simplify and reduce prior authorization.”

Insurers will implement the changes across markets, including business coverage and certain Medicare and Medicaid plans. The group said the tweaks will profit 257 million Americans.

The move comes months after the U.S. medical insurance industry faced a torrent of public backlash following the murder of UnitedHealthcare’s top executive, Brian Thompson. It builds on the work several firms have already done to simplify their prior authorization processes. 

Among the many efforts is establishing a standard standard for submitting electronic prior authorization requests by the beginning of 2027. By then, at the least 80% of electronic prior authorization approvals with all needed clinical documents can be answered in real time, the discharge said. 

That goals to streamline the method and ease the workload of doctors and hospitals, a lot of whom still submit requests manually on paper moderately than electronically. 

Individual plans will reduce the forms of claims subject to prior authorization requests by 2026. 

“We look ahead to collaborating with payers to make sure these efforts result in meaningful and lasting improvements in patient care,” said Shawn Martin, CEO of the American Academy of Family Physicians, in the discharge. 

UnitedHealthcare, in a press release, said it “welcomes the chance to affix other medical insurance plans in our shared commitment to modernize and streamline the prior authorization process.”

The corporate said it builds on its previous efforts, including steps to scale back the variety of services requiring prior authorization. It also includes UnitedHealthcare’s national Gold Card program, which recognizes and awards providers who “consistently adhere to evidence-based care guidelines” by reducing their total prior authorization requests.