American insurers to change the approval process

The health plans of the main American insurers said on Monday that they had voluntarily agreed to accelerate and reduce previous authorizations – a process that is often a major point of pain for patients and providers when obtaining and administration of care.

The prior authorization means that providers obtain the approval of a patient’s insurance company before providing specific services or treatments. Insurers claim that the process guarantees that patients receive medically necessary care and allow them to control costs. But patients and service providers criticized previous authorizations to, in some cases, lead to delays or denial of care and the professional exhaustion of doctors.

Dozens of plans under large insurers such as CVS health,, Unitedhealthcare,, Cigna,, Humana,, Dark And Blue Cross Blue Shield engaged in a series of actions that aim to connect patients to take care more quickly and reduce the administrative burden of service providers, according to an AHIP press release, a commercial group representing health plans. Although companies have applauded changes, they could reduce profits if they led patients using care more often.

“The American health care system must work better for people, and we will improve it in a distinctive manner that counts,” said Steve Nelson, president of the CVS insurer, Aetna, in a press release. “We support industry commitments to rationalize, simplify and reduce prior authorization.”

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

This decision comes from months after the American health insurance industry was faced with a torrent of public reaction following the murder of the best executive of Unitedhealthcare, Brian Thompson. It is based on the work that several companies have already done to simplify their previous authorization processes.

Among the efforts is a joint standard to submit electronic prior authorization requests before the start of 2027. By then, at least 80% of electronic approvals from prior authorization with all the necessary clinical documents will receive a real -time response, according to the press release.

Which aims to rationalize the process and facilitate the workload of doctors and hospitals, many of which Always submit requests manually on paper rather than electronically.

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

“We are impatient to collaborate with payers to guarantee that these efforts lead to significant and lasting improvements in patient care,” said Shawn Martin, CEO of the American Academy of Family Physicians, in the press release.

Unitedhealthcare, in a statement, said that it “welcomes the opportunity to join other health insurance plans in our common commitment to modernize and rationalize the previous authorization process”.

The company said it was based on its previous efforts, including the steps to reduce the number of services requiring prior authorization. It also includes the National of United Healthcare Gold card programwhich recognizes and rewards suppliers who “systematically adhere to the care guidelines based on evidence” by reducing their total authority requests.