The nation's major health insurers are promising to scale back and improve a widely despised practice that leads to care delays and complications. UnitedHealthcare, CVS Health's Aetna, and dozens of other insurers say they plan to reduce the scope of health care claims subject to prior authorization, standardize parts of the process, and expand responses done in real time, per the AP. Prior authorization means insurers require approval before they'll cover medical care, a prescription, or a service like an imaging exam. Insurers say they do this to guard against care overuse and to make sure patients get the right treatment.
But doctors say the practice has grown in scope and complication, leading to frequent care delays. Dr. Mehmet Oz called the practice "a pox on the system" that hikes administrative costs during his Senate confirmation hearing in March to lead the Centers for Medicare and Medicaid Services. Doctors say delays from requests that are eventually approved or coverage rejections can harm patients by giving a disease time to progress untreated. They also can spike anxiety in patients who want to know whether their tumor has stopped growing and if insurance will cover the scan.
Insurers said Monday that they will standardize electronic prior authorization by the end of next year to help speed up the process. They will reduce the scope of claims subject to medical prior authorization, and they will honor the pre-approvals of a previous insurer for a window of time after someone switches plans. They also plan to expand the number of real-time responses and ensure medical reviews are done for denied requests. The insurers say their promises will apply to coverage through work or the individual market as well as Medicare Advantage plans and the state and federally funded Medicaid program. (More health insurance stories.)
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