The nation\u2019s major health insurers are promising to scale back and improve a widely despised practice that leads to care delays and complications.
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\nUnitedHealthcare, 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.<\/p>\n
Prior authorization means insurers require approval before they\u2019ll 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.<\/p>\n
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.
\nDr. Mehmet Oz called prior the practice \u201ca pox on the system\u201d that hikes administrative costs during his Senate confirmation hearing in March to lead the Centers for Medicare and Medicaid Services.<\/p>\n
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 pre-approvals of a previous insurer for a window of time after someone switches plans.
\nThey also plan to expand the number of real-time responses and ensure medical reviews are done for denied requests.<\/p>\n
Researchers say prior authorization has grown more common as care costs have climbed, especially for prescription drugs, lab testing, physical therapy and imaging exams.
\n\u201cWe\u2019re sort of trapped between care being unaffordable and then these non-financial barriers and administrative burdens growing worse,\u201d said Michael Anne Kyle, an assistant professor at the University of Pennsylvania who studies how patients access care.<\/p>\n
Nearly all customers of Medicare Advantage plans, the privately run version of the federal government’s Medicare program, need prior authorization for some services, particularly expensive care like hospital stays, the health policy research organization KFF found in a study of 2023 claims. The study also found that insurers denied about 6% of all requests.
\nDr. Ashley Sumrall of Charlotte, North Carolina, says she has seen an increase in prior authorizations required for routine exams like MRIs. An oncologist who treats brain tumors, Sumrall said these images are critical for doctors to determine whether a treatment is working and to plan next steps.<\/p>\n
Doctors say delays from requests that are eventually approved or coverage rejections can harm patients by giving a disease time to progress untreated. They also can spike anxiety in patients who want to know whether their tumor has stopped growing and if insurance will cover the scan.
\n\u201cThere\u2019s a term that we use called \u2018scanxiety,\u2019 and it\u2019s very real,\u201d said Sumrall, a member of the Association for Clinical Oncology\u2019s volunteer leadership.<\/p>\n
Different forms and varied prior authorization policies also complicate the process. Sumrall noted that every insurer \u201chas their own way of doing business.\u201d
\n\u201cFor years, the companies have been unwilling to compromise, so I think any step in the direction of standardization is encouraging,\u201d she said.<\/p>\n
The insurers say their promises will apply to coverage through work or the individual market as well as Medicare Advantage plans and the state and federally funded Medicaid program.
\nWith the planned improvements to prior authorization, patients and healthcare providers can expect a more streamlined and efficient process, reducing delays and complications in medical care.<\/p>\n
Q: What is prior authorization?
\nA: Prior authorization is a practice where insurers require approval before covering medical care, a prescription, or a service.
\nQ: Why do insurers use prior authorization?
\nA: Insurers use prior authorization to guard against care overuse and ensure patients receive the right treatment.
\nQ: What changes are insurers promising to make to prior authorization?
\nA: Insurers are promising to standardize electronic prior authorization, reduce the scope of claims subject to medical prior authorization, honor pre-approvals from previous insurers, and expand real-time responses.
\nQ: How will these changes impact patients?
\nA: The changes aim to reduce care delays and complications, streamline the process, and decrease anxiety for patients waiting for approval or coverage.
\nQ: When will these changes be implemented?
\nA: Insurers plan to standardize electronic prior authorization by the end of next year.<\/p>\n","protected":false},"excerpt":{"rendered":"
Introduction to Prior Authorization The nation\u2019s 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 […]<\/p>\n","protected":false},"author":2,"featured_media":23158,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"footnotes":""},"categories":[26],"tags":[],"class_list":{"0":"post-23157","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health"},"jetpack_featured_media_url":"https:\/\/i3.wp.com\/media.nbcchicago.com\/2025\/06\/GettyImages-2195574378.jpg?quality=85&strip=all&resize=1200%2C675&w=1200&resize=1200,675&ssl=1","_links":{"self":[{"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/posts\/23157"}],"collection":[{"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/comments?post=23157"}],"version-history":[{"count":1,"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/posts\/23157\/revisions"}],"predecessor-version":[{"id":23159,"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/posts\/23157\/revisions\/23159"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/media\/23158"}],"wp:attachment":[{"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/media?parent=23157"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/categories?post=23157"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/citystuff.com\/chicago\/wp-json\/wp\/v2\/tags?post=23157"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}