UnitedHealthcare, Kaiser Permanente and other major U.S. health insurers say they want to make it faster and easier for patients to obtain care.
Health Insurance Plans (AHIP), a trade association that represents the health insurance industry, announced Monday that some of its biggest members are taking steps to streamline “prior authorization” — industry jargon for the process by which health care providers obtain approval from patients’ insurance carriers to deliver care.
Prior authorization requests can be time-consuming for doctors, resulting in frustrating delays for patients in obtaining essential medical care. According to a survey from the American Medical Association, physicians’ offices spend an average of 12 hours per week seeking approval for services from insurers, administrative hurdles that critics say take time away from providing care.
As part of the new agreement, participating insurers have committed to a series of steps they say will speed up the sluggish process. That includes creating a standardized system for submitting prior authorization online, reducing the amount of claims subject to prior authorization and ramping up real-time responses to requests. Such changes are scheduled to take effect in 2026 and 2027.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” AHIP CEO Mike Tuffin said in a statement. “Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system.”
Shawn Martin, CEO of the American Academy of Family Physicians, said in a statement that the insurance industry initiative is a “step in the right direction,” but that the real test will be the impact it has on the experiences of patients and physicians.
Dozens of insurers signed onto the commitment, including a number of state Blue Cross and Blue Shield plans and some Medicare and Medicaid plans. In all, AHIP says the joint effort to improve prior authorization could benefit more than 250 million Americans.
The signatories include:
AmeriHealth Caritas Arkansas Blue Cross and Blue ShieldBlue Cross of IdahoBlue Cross Blue Shield of AlabamaBlue Cross Blue Shield of ArizonaBlue Cross and Blue Shield of HawaiiBlue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas CityBlue Cross and Blue Shield of LouisianaBlue Cross Blue Shield of MassachusettsBlue Cross Blue Shield of MichiganBlue Cross and Blue Shield of MinnesotaBlue Cross and Blue Shield of NebraskaBlue Cross and Blue Shield of North CarolinaBlue Cross Blue Shield of North DakotaBlue Cross & Blue Shield of Rhode IslandBlue Cross Blue Shield of South CarolinaBlueCross BlueShield of TennesseeBlue Cross Blue Shield of WyomingBlue Shield of CaliforniaCapital Blue CrossCapital District Physicians’ Health Plan, Inc. (CDPHP)CareFirst BlueCross BlueShieldCenteneThe Cigna GroupCVS Health AetnaElevance HealthExcellus Blue Cross Blue ShieldGeisinger Health PlanGuideWell Mutual Holding CorporationHealth Care Service CorporationHealthfirst (New York)Highmark Inc.Horizon Blue Cross Blue Shield of New JerseyHumana Independence Blue CrossIndependent HealthKaiser PermanenteL.A. Care Health PlanMolina HealthcareNeighborhood Health Plan of Rhode IslandPoint32HealthPremera Blue CrossRegence BlueShield, Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Asuris Northwest Health, BridgeSpan HealthSCAN Health PlanSummaCareUnitedHealthcare Wellmark Blue Cross and Blue Shield
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