Roughly three-quarters of the nation’s health insurance providers signed a series of commitments this week in an effort to improve patient care by reducing bureaucratic hurdles caused by insurance companies’ prior-authorization requirements.
Director of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, alongside Health and Human Services Secretary, Robert F. Kennedy Jr., announced the new voluntary pledge from a cadre of insurance providers, who cover roughly 75% of the population, during a press conference Monday. The new commitments are aimed at speeding up and reducing prior-authorization processes used by insurers, a process that has been long-maligned for unnecessarily delaying patient care and other bureaucratic hurdles negatively impacting patients.
‘The pledge is not a mandate. It’s not a bill, a rule. This is not legislated. This is a opportunity for industry to show itself,’ Oz said Monday. ‘But by the fact that three-quarters of the patients in the country are already covered by participants in this pledge, it’s a good start and the response has been overwhelming.’
Prior-authorization is a process that requires providers to obtain approval from a patient’s insurance provider before that provider can offer certain treatments or services. Essentially, the process seeks to ensure patients are getting the right solution for a particular problem.
However, according to Oz, the process has led to doctors being forced to spend enormous amounts of man-power to satisfy prior-authorization requirements from insurers. He noted during Monday’s press conference that, on average, physicians have to spend 12 hours a week dealing with these requirements, which they see about 40 of per week.
‘It frustrates doctors. It sometimes results in care that is significantly delayed. It erodes public trust in the healthcare system. It’s something we can’t tolerate,’ Oz insisted.
The pledge has been adopted by some of the nation’s largest insurance providers, including United Healthcare, Cigna, Humana, Blue Cross & Blue Shield, Aetna and many more. While the industry-led commitments aim to improve care for patients, it could potentially eat into their profits as well if patients start seeking care more often.
The commitments from insurers cemented this week include taking active steps to implement a common standardized process for electronic prior-authorization through the development of standardized submission requirements to support faster turnaround time. The goal is for the new framework to be operational by Jan. 1, 2027.
Another part of the pledge includes a commitment from individual insurance plans to implement certain reductions in its use of medical prior-authorization by Jan. 1, 2026. On that date, if patients switch insurance providers during the course of treatment, their new plan must honor their existing prior-authorization approvals for 90-days while the patient transitions.
Transparency is also a key part of the new commitments from insurance providers. Health plans enjoined with the commitments will pledge to provide clear and easy-to-understand explanations of prior-authorization determinations, including guidance for appeals. The commitment also states that by 2027, 80% of electronic prior-authorization approvals from companies will be answered in real-time.
Oz, during the Monday press conference, compared the industry-led pledge to the Bible, saying, ‘The meek shall inherit the earth.’
‘I always grew up thinking ‘meek’ meant weak, but that’s not what meek means. ‘Meek’ means you have a sharp sword, a sword that could do real damage to people around you, but you decide, electively, to sheathe that sword and put it away for a while, so you can do goods, so you can do important things where once in a while we have to get together, even if we’re competitors, and agree,’ Oz said Monday.
‘That’s what these insurance companies and hospital systems have done,’ he continued. ‘They have agreed to sheathe their swords to be meek for a while, to come up with a better solution to a problem that plagues us all.’