The nation’s major health insurers are promising to reform a widely criticized practice that leads to care delays and complications. Prior authorization, where insurers require approval before covering medical care or services, will be reduced in scope and standardized by the end of next year.
This process is intended to prevent overuse of care and ensure patients receive the right treatment. However, doctors say the practice has become overly complex, leading to frequent delays. Insurers claim standardizing electronic prior authorization will speed up the process, while also honoring preapprovals for a limited time after switching plans.
Researchers note that prior authorization has increased in recent years as healthcare costs have risen. Nearly all Medicare Advantage plan customers require prior authorization for certain services, including expensive care like hospital stays. The health policy research organization KFF found that insurers denied about 6% of requests.
Doctors warn that delays and coverage rejections can harm patients by allowing diseases to progress untreated and causing anxiety. While the new measures aim to standardize the process, some say it’s essential to address the complexity of prior authorization policies across different insurers. The insurers’ promises will apply to various insurance plans, including work, individual market, Medicare Advantage, Medicaid, and other programs.
Source: https://www.pbs.org/newshour/politics/watch-live-kennedy-and-medicare-and-medicaid-head-dr-oz-make-health-insurance-announcement