Robert Kennedy Jr., testifying in January at a Senate Finance Committee nomination hearing. Credit: Senate Finance
Health insurers and their trade groups told Robert F. Kennedy Jr. and other federal regulators today that they will try to make the process of administering advance approval for patients' requests for coverage simpler and faster.
America's Health Insurance Plans, the Blue Cross Blue Shield Association and the groups' member companies said that they will join together to:
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◆ Develop a standard electronic prior authorization process.
◆ Reduce the scope of prior authorization review programs.
◆ Ensure that patients who change plans can continue with the course of treatment previously authorized.
◆ Simplify prior authorization determination messages.
◆ Get determination messages back to physicians and patients more quickly.
◆ Stick with the current practice of having live-human physicians review prior authorization denials that are related to clinical considerations.
The carriers that belong to AHIP and the Blue Cross Blue Shield Association provide or administer health coverage for 257 million people.
The groups and the carriers made their announcement as Kennedy — the secretary of the U.S. Department of Health and Human Services — and Dr. Mehmet Oz, the administrator in charge of a key HHS agency, the Centers for Medicare and Medicaid Services, said they would work to do whatever they can to fix the prior authorization program.
"Thank you to the insurance companies for making these commitments today," Kennedy said at an in-person health insurance industry meeting held in Washington. "Americans shouldn't have to negotiate with their insurer to get the care they need."
Oz is a cardiothoracic surgeon who has often talked about trying to make physicians' lives easier by reducing the number of procedures subject to prior authorization procedures.
Oz praised the health insurers' promises to improve prior authorization programs.
"We applaud these voluntary actions by the private sector, which is how these types of issues should be solved," Oz said. "CMS will be evaluating progress and driving accountability toward our shared goals."
The history: Health insurers have often announced major efforts to improve priority authorization and claim determination processes.
Two of the major goals of the Health Insurance Portability and Accountability Act of 1996 were simplifying coverage administration and promoting health data interchange standards.
AHIP and the Blues joined with the American Hospitalization, the American Medical Association and other groups to unveil a prior authorization improvement project in 2018.
Related: Insurer groups join effort to ease prior authorization nightmares
Health insurers suspended many prior authorization review activities during the peak years of the COVID-19 pandemic.
In 2022, health insurance groups supported a Medicare prior authorization improvement bill introduced in both the House and the Senate.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
