Health Insurance Industry Takes Steps to Simplify Preapproval Process
In a significant move responding to public outcry surrounding the complexities of medical care access, the health insurance industry announced on Monday plans to streamline the prior authorization process. This announcement follows the tragic death of UnitedHealthcare CEO Brian Thompson earlier this year, which intensified frustrations over care denials.
Dozens of health insurers covering 257 million Americans pledged to implement six key measures aimed at enhancing the efficiency of care approvals for those enrolled in commercial, Medicare Advantage, and Medicaid-managed care plans. These changes aim to facilitate quicker access to necessary treatments, reduce administrative burdens for healthcare providers, and ensure a more transparent decision-making process.
Beginning in January 2024, insurers will reduce the number of claims requiring preapproval and maintain existing prior authorizations for 90 days amidst policyholder transitions. A unified electronic authorization system is set to be in place by January 2027, targeting an 80% real-time approval rate, provided necessary documentation is submitted.
Major carriers including UnitedHealthcare, Cigna, and Humana are leading the charge in reforming practices to alleviate patient challenges associated with prior authorizations. U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz are set to discuss these reforms at a news conference.
While insurers defend prior authorization as a vital safety measure, critics argue it often serves as a barrier to essential care, emphasizing the need for these new initiatives.
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