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,<\/a> 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<\/a> for unnecessarily delaying patient care and other bureaucratic hurdles negatively impacting patients. \u00a0\u00a0<\/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 A NEW LAW IN THIS STATE BANS AUTOMATED INSURANCE CLAIM DENIALS<\/u><\/strong><\/a><\/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<\/a>. 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.\u00a0<\/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 DR. OZ SAYS TAXPAYERS FOOTING $14 BILLION BILL FOR MEDICAID FRAUD WHILE ELIGIBLE PATIENTS STRUGGLE FOR CARE<\/strong><\/a>\u00a0<\/p>\n The pledge has been adopted by some of the nation’s largest insurance providers, including United Healthcare,<\/a> 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