Starting this week, major health insurance companies, including United Healthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente, and Humana, announced plans to “streamline, simplify and reduce prior authorizations.” These changes will be phased in over the next 18 months and will affect 257 million Americans.
Addressing Widespread Complaints.
Prior authorization, a process where doctors or hospitals must get approval from insurers before providing certain care or prescriptions, has been a long-standing source of complaints from doctors and patients, who say it delays or denies necessary care. Surveys indicate nearly 1 in 5 adults experienced a prior authorization problem in the past year.
Specific Vowed Changes.
Insurers promise faster access for patients, fewer challenges, a reduction in the scope of claims subject to prior authorization, measures for continuity of care when patients switch plans, clearer explanations for decisions, and standardization of computer systems for processing requests to “put patients over paperwork.”
Skepticism Due to Past Failures.
This isn’t the first time insurers have agreed to address prior authorization issues; a similar effort in 2018 did not lead to significant progress.
Andrew Mignatti, CEO of careviso, a healthcare transparency software company, says in the past, delays and denials have frustrated both doctors and patients, and why past reform efforts have fallen short.
With this new round of voluntary insurer commitments, Mignatti says he wants to watch for as changes roll out, and where skepticism remains about meaningful improvements.
Another benefit about the changes is it should help speed up the process when dealing with patients like real-time benefits verification and standardized electronic authorizations—can reduce paperwork, speed up approvals, and improve transparency.
“Further steps are needed from both insurers and regulators to ensure reforms truly benefit patients and providers, not just insurance company bottom lines,” said Andrew Mignatti.
Author
