Insurers step up prior authorization reforms 

Insurers step up prior authorization reforms 

Major health insurance companies on Friday said they were accelerating efforts to streamline prior authorization requirements and reduce administrative burdens for providers. 

The commitment was signed by about 50 companies, including UnitedHealthcare, Aetna and Cigna. It comes as insurers face mounting scrutiny on Capitol Hill for prior authorization practices that providers argue can delay or block necessary care.

Under the new agreement, participating plans are adopting a standardized approach for providers submitting electronic prior authorization requests for services such as orthopedic surgeries and imaging like CT scans and MRIs.  

These services span commercial coverage, Medicare Advantage and Medicaid managed care. 

UnitedHealthcare said more than half of its prior authorization volume will be incorporated into the standardization process, with that share expected to exceed 70 percent by the end of 2026. 

The announcement could help insurers cast themselves as stewards of affordability, helping to keep providers from ordering unnecessary services — and keeping facilities from getting paid for them.  

A House panel is set to grill health system executives next week on health care affordability. 

“This is a meaningful step forward toward giving patients faster answers, more certainty, and fewer unnecessary delays in care,” Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, wrote on X. “I applaud these efforts from a collection of the largest health plans across most market segments as momentum builds. We........

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