Insurers Promise to Speed Up Delays in Health Care Approvals

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By I. Edwards HealthDay Reporter

Medically reviewed by Carmen Pope, BPharm. Last updated on June 25, 2025.

via HealthDay

WEDNESDAY, June 25, 2025 — Getting approval from your insurance company before a procedure or treatment may soon get a little easier.

U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said this week that several of the nation’s largest health insurers have agreed to change how they handle prior authorization, a system that often causes delays in care.

About 1 in 6 insured adults in the U.S. say they’ve had trouble with prior authorizations, according to a recent survey from health policy group KFF.

Now, major insurers — including Blue Cross Blue Shield Association, Cigna, Elevance Health, GuideWell, Humana, Kaiser Permanente and UnitedHealthcare — say they’ll take steps to fix the issue, NBC News reported.

The changes will apply to people with private insurance, Medicare Advantage and Medicaid, Kennedy said.

An industry group called AHIP (formerly known as America’s Health Insurance Plans) said the updates could help as many as 257 million people.

But experts say the changes may not go far enough.

It’s “going to streamline it in some incremental ways only,” Dr. Adam Gaffney, a critical care doctor and assistant professor at Harvard Medical School, told NBC News.

Insurance companies have promised changes like these before, in 2018 and 2023, but many didn’t follow through, Dr. Mehmet Oz, head of the Centers for Medicare & Medicaid Services (CMS), said.

When asked what’s different this time, Oz referred to the fatal shooting of a top UnitedHealthcare executive last year, calling it a sign of growing public frustration.

“There’s violence in the streets over these issues,” Oz said.

AHIP previewed some of the coming changes.

Starting next year, if a patient switches insurance plans while getting treatment, the new plan must honor the old plan’s prior authorization for at least 90 days.

Insurers must provide clearer explanations when care is denied and explain how patients can appeal.

Medical professionals will be required to review all denials (though insurers say they already do this).

By 2027, at least 80% of electronic prior authorization requests will be answered in real time, and the process will be easier to do online.

Some plans may also cut back on the number of procedures that need prior approval in certain areas, although specific examples weren’t shared.

CMS said it hopes insurers will stop requiring prior authorizations for common things such as colonoscopies, cataract surgery and childbirth.

Officials are also working to improve access to physical therapy, diagnostic imaging and outpatient surgery.

Still, some experts remain skeptical.

“Talk is cheap,” Gaffney said. “More fundamental reform will be needed to address the ubiquitous barriers to care imposed by insurance firms.”

Sources

  • NBC News, June 23, 2025

    • Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

    Source: HealthDay

    Posted : 2025-06-26 06:00

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