Health Insurance Companies Pledge New Efforts To Eliminate Prior Authorization Headaches

One of the biggest frustrations in getting medical care — prior authorization from insurance companies — might get easier soon.Some of America’s biggest health insurance companies are now pledging to improve on that major pain-point for both doctors and patients. The process can not only slow treatment, it also shifts costs to the patients to pay for doctor-recommended treatment if coverage is denied by insurance providers.Calling the current system broken, the administrator of the Centers for Medicare and Medicaid Services, Mehmet Oz, says insurance companies that cover a majority of people with private health care and marketplace plans have promised to undertake reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers.“There are some things that we should not be preauthorizing anymore and we should stop that and the insurance industry agrees with that, by the way,” Dr. Oz says. Common procedures like colonoscopies and vaginal childbirth are examples of procedures that health officials say should not require preauthorization. Dr. Oz and the secretary of the Department of Health and Human Services, Robert F. Kennedy Jr., say health insurance companies that cover nearly eight out of 10 Americans are now pledging to tackle six reforms aimed at dramatically reducing red tape in the health care industry.The reforms include standardizing electronic prior authorization submissions across the industry, reducing the volume of medical services subject to prior authorization, and honoring existing authorizations during insurance transitions to ensure continuity of care.The companies are also promising to enhance transparency and communication around authorization decisions and appeals, expand real-time responses to minimize delays in care with real-time approvals for most requests, and ensure medical professionals review all clinical denials.Companies that back the reforms were represented at a roundtable with federal officials on Monday. Among them were Aetna, AHIP, Blue Cross Blue Shield, Centene, Cigna, Elevance, GuideWell, Highmark, Humana, Kaiser Permanente, and UnitedHealthcare.Dr. Oz noted that the companies are taking a pledge and are not facing a mandate, but warned, “If the insurance industry can not address the issues of preauthorization by themselves, there are government opportunities to get involved. They might not be as nimble but they will be used if we are forced to use them.”Health officials say that 85 percent of Americans have reported experiencing delays in healthcare because of prior authorization requirements. Mr. Kennedy says common services such as diagnostic imaging, physical therapy, and outpatient surgery should be easier to get approved.“Americans shouldn’t have to negotiate with their insurer to get the care they need,” Mr. Kennedy says. “Pitting patients and their doctors against massive companies was not good for anyone.”The co-chairman of the House GOP Doctors Caucus, Congressman Greg Murphy, was at Monday’s announcement and says medical practices have to hire many more staff just simply to fight with insurance companies. He applauds the promise of reform.“As a physician for over 30 years, I witnessed the ridiculous and ever-increasing obstructions caused by insurance companies to delay or deny care to patients,” Mr. Murphy says. “These bureaucratic hurdles end up hurting patients and those who care for them.”

Health Insurance Companies Pledge New Efforts To Eliminate Prior Authorization Headaches

Health Insurance Companies Pledge New Efforts To Eliminate Prior Authorization Headaches

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