Insurers Pledge to Overhaul Prior Authorization
But will the changes truly benefit patients?
Frustration is mounting as insurance companies demand extra paperwork before approving treatments. Now, some of the nation’s largest insurers are promising to reduce delays caused by so-called prior authorization. But can they be trusted?
The Prior Authorization Problem
The Kaiser Family Foundation found that about 16% of insured adults have had issues with prior authorization. This requirement has become a significant hurdle in the U.S. health care system, delaying necessary care for patients.
Health and Human Services Secretary Robert F. Kennedy Jr. recently announced that several major insurers have committed to overhauling the prior authorization system.
“I think the question is whether this is actually going to come to fruition,”
said Miranda Yaver, a health policy professor at the University of Pittsburgh, in an interview with National Public Radio (NPR). “We’ll have to see to what extent they make good on their promise, because right now, it is a pledge.”
Despite previous promises from insurers, little has changed over the years. At a press event on June 30, both Secretary Kennedy Jr. and Centers for Medicare & Medicaid Services (CMS) administrator Dr. Mehmet Oz acknowledged the repeated failures to streamline the authorization process.
A Breaking Point?
“There’s violence in the streets over these issues,”
said Dr. Oz, alluding to the tragic 2024 killing of former UnitedHealthcare CEO Brian Thompson. The suspect, Luigi Mangione, had a history of expressing anger over insurance denials for his chronic back pain treatments.
A survey by the National Opinion Research Center (NORC) at the University of Chicago indicated that approximately 7 in 10 adults believe insurance denials or health insurance company profits bear at least “a moderate amount” of responsibility for Thompson’s death.
Six Key Changes Promised
Federal health officials assert that the prior authorization process should be faster and clearer by the end of the year. The Department of Health and Human Services, along with AHIP, the leading lobbying group for insurers, outlined six key changes:
- Move to online prior authorization systems.
- Reduce the number of services needing prior approval.
- Make approvals portable across insurance plans.
- Improve transparency with timely updates and appeal processes.
- Expedite routine care with instant approvals.
- Require licensed medical professionals to review clinical denials.
In a recent report, the American Medical Association found that 88% of physicians surveyed reported that prior authorization led to care delays, and 35% said it led to serious adverse events for patients (AMA 2023).
Even with these proposed reforms, government agencies face obstacles. For example, proposals have surfaced that would require some Medicaid recipients to regularly prove they are working to maintain coverage.
Whether these changes will provide meaningful relief or prove to be empty promises remains to be seen.