Health Insurers Pledge To Reform Coverage Reviews Amid Complaints And Delays

The nation’s major health insurers are promising to scale back and improve a widely despised practice that leads to care delays and complications.

UnitedHealthcare, CVS Health’s Aetna and dozens of other insurers say they plan to reduce the scope of health care claims subject to prior authorization, standardize parts of the process and expand responses done in real time.

Prior authorization means insurers require approval before they’ll cover medical care, a prescription or a service like an imaging exam. Insurers say they do this to guard against care overuse and to make sure patients get the right treatment.

But doctors say the practice has grown in scope and complication, leading to frequent care delays. The fatal shooting of UnitedHealthcare CEO Brian Thompson in December prompted many people to vent their frustrations with coverage issues like prior authorization.The nation’s major health insurers are promising to scale back and improve a widely despised practice that leads to care delays and complications.

UnitedHealthcare, CVS Health’s Aetna and dozens of other insurers say they plan to reduce the scope of health care claims subject to prior authorization, standardize parts of the process and expand responses done in real time.

Prior authorization means insurers require approval before they’ll cover medical care, a prescription or a service like an imaging exam. Insurers say they do this to guard against care overuse and to make sure patients get the right treatment.

But doctors say the practice has grown in scope and complication, leading to frequent care delays. The fatal shooting of UnitedHealthcare CEO Brian Thompson in December prompted many people to vent their frustrations with coverage issues like prior authorization.

Dr. Mehmet Oz called the practice “a pox on the system” that hikes administrative costs during his Senate confirmation hearing in March to lead the Centers for Medicare and Medicaid Services.

Insurers said Monday that they will standardize electronic prior authorization by the end of next year to help speed up the process. They will reduce the scope of claims subject to medical prior authorization, and they will honor the preapprovals of a previous insurer for a window of time after someone switches plans.