Several of the nation’s largest health insurance companies have agreed to ease restrictions around prior authorizations, a move that federal health officials claim could speed up care for millions of patients and reduce administrative headaches for doctors.
The pledge came after a recent meeting between the U.S. Health Secretary Robert F. Kennedy Jr., Centers for Medicare and Medicaid Services Administrator Mehmet Oz, and executives from companies including UnitedHealthcare, Aetna, Cigna, Humana, Kaiser Permanente and the Blue Cross Blue Shield Association.
The companies agreed to adopt six reforms aimed at reducing the number of medical services that require prior authorization, standardizing digital forms, and ensuring patients don’t lose access to treatment when they change insurance plans mid-care.
“There shouldn’t be paper, there shouldn’t be faxes, there shouldn’t be letters being sent,” Oz said at a news conference. “They should all be done digitally and automatically, and 90-day continuity should exist for authorizations when patients switch insurers, so you never fall through the cracks again.”
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Prior authorization is the process by which insurers require doctors to get approval before delivering certain treatments, tests, or medications. While insurance companies say it helps control costs and ensure appropriate care, doctors and patient advocates say it often leads to delays, denials, and unnecessary bureaucracy.
“The reality is that doctors have prior authorizations piling up on their desks every single week,” Dr. Jaime Seeman, a board-certified OB-GYN, previously told NewsNation’s Chris Cuomo. She said the paperwork includes requests for everything from imaging to surgeries and is “taking productivity out of our workforce.”
More than nine in 10 physicians reported that prior authorization caused care delays in 2023, according to a survey by the American Medical Association.
“I use the word moral injury because it really makes my blood boil when we signed up to take care of patients and we’re constantly being questioned by insurance companies,” Seeman told NewsNation.
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According to Oz, about 6,000 procedures currently require prior authorization each year, but only about 2,000 to 3,000 of those should actually need it. He said the new industry pledge could significantly reduce that number.
“If the insurance industry cannot address the needs of pre-authorization by themselves, there are government opportunities to get involved,” Oz said.
While the pledge is not legally binding, health officials say it could still have a wide impact. Roughly 257 million Americans are covered by the insurance companies that took part in the meeting, according to Kennedy.
“These companies have now agreed to unify their protocols so that all of them will communicate in the same way,” Kennedy said. “That’s going to dramatically change the patient experience.”
The pledge was first announced Monday by AHIP, the insurance industry’s main trade group, and later confirmed by the Department of Health and Human Services.
Oz said three-quarters of U.S. patients are insured by companies participating in the pledge. The full list of health plans will be released later this summer.
The prior authorization system has come under increasing scrutiny in recent years. Patients and doctors have taken to social media to criticize delays, and in some tragic cases, those delays have been linked to adverse outcomes.
“There’s violence in the streets over these issues,” Oz said. “This is not something that is a passively accepted reality anymore. Americans are upset about it.”
Health officials said the reforms won’t take effect overnight but are part of a longer-term strategy to modernize the process and shift more of it online.
“This pledge is a first step,” Kennedy said, “but we’re going to keep watching to make sure these promises turn into real action.”
