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.<\/p>\n
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. <\/p>\n
‘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.’<\/p>\n<\/p>\n
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.<\/p>\n
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. <\/p>\n
‘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.<\/p>\n
<\/p>\n
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.<\/p>\n
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.<\/p>\n
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.<\/p>\n<\/p>\n
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. <\/p>\n
Oz, during the Monday press conference, compared the industry-led pledge to the Bible, saying, ‘The meek shall inherit the earth.’<\/p>\n
‘I always grew up thinking \u2018meek\u2019 meant weak, but that’s not what meek means. \u2018Meek\u2019 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.<\/p>\n
‘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.’<\/p>\n<\/p>\n
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