The signaling of UnitedHealthcare is shown in an office building in Phoenix, Arizona, on July 19, 2023.
Patrick T. Fallon | AFP | Getty images
Health plans under the main insurers of the United States said on Monday that they have voluntarily accepted and reduce previous authorizations, a process that is often an important pain point for patients and suppliers by obtaining and managing care.
Prior authorization makes suppliers obtain the approval of a patient's insurance company before carrying out specific services or treatments. Insurers say the process ensures that patients receive medically necessary care and allows them to control costs. But patients and suppliers have criticized previous authorizations for, in some cases, which leads to delays in care or denial and exhaustion of the doctor.
Dozens of plans under large insurance companies such as CVS health, UnitedHealthcare, CIGNA, Human, Elevation health and Blue Cross Blue Shield committed to a series of actions that aim to connect patients with more rapid care and reduce administrative load for suppliers, according to an AHIP statement, a commercial group that represents health plans.
Insurers will implement changes in markets, including commercial coverage and certain Medicare and Medicaid plans. The group said the adjustments will benefit 257 million Americans.
The measure occurs months after the US health insurance industry faced a public reaction torrent after the murder of the main executive of Unithedhealthcare, Brian Thompson. It is based on the work that several companies have already done to simplify their previous authorization processes.
Among the efforts is establishing a common standard to send electronic requests for prior authorization at the beginning of 2027. By then, at least 80% of the approval of prior electronic authorization with all the necessary clinical documents will be responded in real time, according to the statement.
This aims to streamline the process and relieve the workload of doctors and hospitals, many of whom still send requests manually on paper instead of electronically.
Individual plans will reduce the types of claims subject to prior authorization requests by 2026.
“We hope to collaborate with the payers to ensure that these efforts lead to significant and lasting improvements in patient care,” said Shawn Martin, CEO of the American Academy of Family Physicians, in the statement.
