Kennedy says health insurers promise to change prior authorization process

WASHINGTON — Health and Human Services Secretary Robert F. Kennedy Jr. said Monday that the country’s largest wellness insurers person promised to instrumentality steps to streamline the often-criticized prior authorization process, which tin hold oregon contradict patients’ entree to care.

Prior authorization is a cost-cutting tool utilized by wellness insurers that requires them to motion disconnected connected tests, procedures oregon drugs earlier patients tin get them.

The security maneuver drew renewed attraction past twelvemonth aft the fatal shooting of Brian Thompson, the CEO of UnitedHealth’s security arm, successful New York City.

Patients and doctors accidental anterior authorization creates excessively galore roadblocks, forcing radical to hold days oregon weeks for needed treatments oregon denying them altogether.

About 1 successful 6 insured adults accidental they’ve had anterior authorization problems, according to a survey from KFF, a wellness argumentation probe group.

Kennedy said a fig of ample security companies — including Blue Cross Blue Shield Association, Cigna, Elevance Health, GuideWell, Humana, Kaiser Permanente and UnitedHealthcare — pledged to marque the changes, which volition beryllium implemented crossed backstage insurance, Medicare Advantage and Medicaid.

AHIP, a wellness security manufacture commercialized group, said the changes could payment 257 cardinal radical successful the United States.

Experts stressed, however, that anterior authorization isn't going away.

It’s “going to streamline it successful immoderate incremental ways only,” said Dr. Adam Gaffney, a captious attraction doc and adjunct prof astatine Harvard Medical School.

Health security companies person made akin commitments to hole anterior authorization successful the past, a information Kennedy and Dr. Mehmet Oz, head of the Centers for Medicare & Medicaid Services (CMS), acknowledged astatine a media lawsuit Monday. In 2018 and again successful 2023, wellness security companies made commitments to betterment anterior authorization, Oz said, but galore failed to instrumentality specified reforms.

Asked what’s antithetic this time, helium said, “There’s unit successful the streets implicit these issues,” alluding to the shooting of Thompson.

AHIP — formerly America’s Health Insurance Plans — elaborate the steps wellness security companies committed to successful a news release earlier Monday.

Starting adjacent year, if patients power security plans portion they are receiving treatment, their caller plans volition grant the existing anterior authorizations for akin attraction for up to 90 days. In addition, adjacent year, insurers volition request to supply easier-to-understand explanations erstwhile they contradict authorizations and connection guidance astir however to appeal.

Insurers person pledged to person aesculapian professionals reappraisal each authorization denials, though AHIP said that is thing that insurers accidental they already do.

Insurers person besides committed to streamline the anterior authorization process by making it easier to taxable requests online by 2027. At slightest 80% of physics requests volition beryllium answered successful existent clip by 2027, AHIP said.

Plans whitethorn besides trim the fig of aesculapian services taxable to anterior authorizations successful definite cities oregon states — though circumstantial commitments astir what that mightiness see were lacking.

Chris Klomp, who leads the Medicare programme astatine CMS, said the bureau would similar insurers to rotation backmost anterior authorization requirements for communal services, including colonoscopies, cataract country and childbirth.

Kennedy besides said CMS is moving with insurers to marque it easier to get anterior authorization for diagnostic imaging, carnal therapy and outpatient surgery.

Gaffney criticized the pledges, saying insurers person had decades to alteration their practices.

“Talk is cheap,” Gaffney said. “More cardinal betterment volition beryllium needed to code the ubiquitous barriers to attraction imposed by security firms.”

Kaye Pestaina, manager of the programme connected diligent and user extortion astatine KFF, said immoderate of commitments could person nonstop impacts connected patients, specified arsenic honoring existing anterior authorizations for 3 months aft patients power insurers.