U.S. insurers to change approval process

Health plans under major U.S. insurers said Monday they have voluntarily agreed to speed up and reduce prior authorizations – a process that is often a major pain point for patients and providers when getting and administering care.

Prior authorization makes providers obtain approval from a patient’s insurance company before they carry out specific services or treatments. Insurers say the process ensures patients receive medically necessary care and allows them to control costs. But patients and providers have slammed prior authorizations for, in some cases, leading to care delays or denials and physician burnout.

Dozens of plans under large insurers such as CVS Health, UnitedHealthcare, Cigna, Humana, Elevance Health and Blue Cross Blue Shield committed to a series of actions that aim to connect patients to care more quickly and reduce the administrative burden on providers, according to a release from AHIP, a trade group representing health plans. Though the companies cheered the changes, they could cut into profits if they lead to patients using care more often.

“The American health care system must work better for people, and we will improve it in distinctive ways that truly matter,” said Steve Nelson, president of CVS’ insurer, Aetna, in a statement. “We support the industry’s commitments to streamline, simplify and reduce prior authorization.”

Insurers will implement the changes across markets, including commercial coverage and certain Medicare and Medicaid plans. The group said the tweaks will benefit 257 million Americans.

The move comes months after the U.S. health insurance industry faced a torrent of public backlash following the murder of UnitedHealthcare’s top executive, Brian Thompson. It builds on the work several companies have already done to simplify their prior authorization processes. 

Among the efforts is establishing a common standard for submitting electronic prior authorization requests by the start of 2027. By then, at least 80% of electronic prior authorization approvals with all necessary clinical documents will be answered in real time, the release said. 

That aims to streamline the process and ease the workload of doctors and hospitals, many of whom still submit requests manually on paper rather than electronically. 

Individual plans will reduce the types of claims subject to prior authorization requests by 2026. 

“We look forward to collaborating with payers to ensure these efforts lead to meaningful and lasting improvements in patient care,” said Shawn Martin, CEO of the American Academy of Family Physicians, in the release. 

UnitedHealthcare, in a statement, said it “welcomes the opportunity to join other health insurance plans in our shared commitment to modernize and streamline the prior authorization process.”

The company said it builds on its previous efforts, including steps to reduce the number of services requiring prior authorization. It also includes UnitedHealthcare’s national Gold Card program, which recognizes and awards providers who “consistently adhere to evidence-based care guidelines” by reducing their total prior authorization requests.