(NewsNation) — The nation’s major health insurers are pledging to streamline the prior authorization process, which has long frustrated Americans by delaying care and creating complications.
“Patients should not be waiting because bureaucratic hurdles are blocking their medical treatment,” Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said at a press conference unveiling the pledge on Monday afternoon.
Participating health insurers are promising to make six key reforms, according to the U.S. Department of Health and Human Services (HHS).
Those changes include standardizing the electronic prior authorization process, reducing the number of services subject to prior authorization and enhancing transparency around authorization decisions.
“Pitting patients and their doctors against massive companies was not good for anyone,” Health Secretary Robert F. Kennedy Jr., said in a statement.
What is prior authorization?
Prior authorization has long been a contentious issue, requiring insurers to approve medical care before it’s covered, a process that often leads to delays.
The idea is to make sure care is necessary and cost-effective, but the practice has become more widespread and increasingly complex over time.
With Monday’s announcement, it should become easier for patients to get prior authorization for common services like diagnostic imaging, physical therapy, and outpatient surgery, Kennedy said.
HHS said health insurers will expand real-time responses so there will be real-time approvals for most requests by 2027.
Oz clarified that the pledge is not a mandate and participation by insurers is voluntary.
“They’ve agreed to sheath their swords…to come up with a better solution to a problem that plagues us all,” Oz said Monday.
Kennedy said during an appearance on NewsNation’s “CUOMO” that HHS and health insurers agreed upon a list of things that would no longer require prior authorization, and if they are not in compliance with them, they would face penalties.
“We have regulatory sanctions if they don’t do that that are now before Congress,” Kennedy said. “I’m cautiously confident that they’re going to do it, it’s trust verified, but I think this is closer than we’ve ever gotten and the agreements are very, very solid.”
Why are prior authorizations a hassle?
Prior authorization imposes an expensive administrative burden on physicians and often delays medical care for patients.
“The reality is that doctors have prior authorizations piling up on their desks every single week,” Dr. Jaime Seeman, a board-certified OB-GYN, told NewsNation’s Chris Cuomo in March.
That stack of paperwork includes everything from medications to imaging to surgeries, all of which, Seeman said, is “taking productivity out of our workforce” and harming patients.
Last year, more than 9 in 10 physicians (93%) reported care delays while waiting for insurers to authorize necessary care, according to a survey by the American Medical Association, which represents the nation’s doctors.
“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 Cuomo.
Some 257 million Americans are covered by the group of health insurance companies that have pledged to make changes to the pre-authorization process, Kennedy said Monday.
“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.”
UnitedHealthcare, CVS Health’s Aetna and dozens of other insurers have all committed to simplifying the prior authorization process.