A coalition of health insurance companies is vowing to make changes to the prior authorization process, after years of patients and providers’ complaints over a system they say delays care and endangers people’s health.
On Monday, federal health officials met with representatives from some of the country’s major insurance companies, including Aetna, Blue Cross Blue Shield Association, Cigna, Kaiser Permanente, and UnitedHealthcare. The coalition of insurers voluntarily pledged to streamline the widely criticized process.
The insurance companies, as well as Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz, touted the commitment as a step toward improving the country’s health care system.
But this isn’t the first time insurers have pledged to reform the process in recent years, as it has drawn fierce criticism.
Here’s what to know about prior authorization, and what insurers have vowed to do.
What is prior authorization?
Prior authorization refers to when medical providers have to get approval from insurers before performing a service.
Why is it so contentious?
Patients and providers have criticized insurance companies for denying prior authorization requests, saying that them doing so prevents or delays patients from accessing care that is recommended by their doctors.
Almost one in three physicians report that prior authorization requests are frequently or always denied, and about 75% said the number of denials has increased somewhat or significantly over the last five years, according to a 2024 survey conducted by the American Medical Association. About 93% of physicians reported that prior authorization delayed access to necessary care, and 82% said that the process can, at least sometimes, lead to patients abandoning treatment altogether, the survey found. More than one in four physicians who responded to the survey reported that the process has led to a serious adverse event for a patient they were treating.
Read more: What to Do When Health Insurance Denies Care You Really Need
The fatal shooting in December of UnitedHealthcare CEO Brian Thompson, who had been on his way to an investor meeting in New York at the time of the attack, made national headlines and drew renewed attention to the controversies surrounding prior authorization.
Oz said during a press conference that there has been “violence in the streets over these issues,” in an apparent reference to the shooting.
“This is not something that is a passively accepted reality anymore—Americans are upset about it,” Oz said.
Insurers have promised to reform the process before
Health insurance companies have made similar promises to revamp prior authorization in the past—in both 2018 and 2023, some insurers pledged to improve the process. But experts criticized the companies for failing to make substantial changes.
UnitedHealthcare has said that, this year, it will aim to reduce the total number of services requiring prior authorization by nearly 10%.
In February, Cigna committed to making a number of changes to the process, such as announcing plans to invest in resources that would help more patients resolve issues with prior authorization faster, as well as streamline the process for physicians to submit requests.
What are they committing to do now?
According to a press release from the Department of Health and Human Services (HHS), the coalition of health insurers on Monday committed to six reforms:
- Standardize electronic prior authorization submissions
- Reduce the number of medical services that require prior authorization by Jan. 1, 2026
- Honor existing authorizations while patients are switching to another insurance plan to ensure that ongoing care is uninterrupted
- Improve transparency and communication regarding authorization decisions and appeals
- Decrease delays by expanding real-time approvals for most requests by 2027
- Ensure that medical professionals review all denials for clinical care and services
What do RFK Jr. and Dr. Oz say?
Kennedy thanked the insurers who pledged to make reforms.
“Americans shouldn’t have to negotiate with their insurer to get the care they need,” he said in the press release. “Pitting patients and their doctors against massive companies was not good for anyone. We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”
Noting Americans’ mounting negative feelings toward the process, Oz said in a press release from HHS that the commitment from insurance companies was “a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care.”
