Prior authorizations fell after insurer pledges
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Health insurers say they've cut pre-treatment claim reviews by 11% in the past year after committing to streamlining requirements for patients and doctors.
Why it matters: The so-called prior authorizations help control health care spending, but they can discourage patients from getting treatment and add administrative burden for providers.
State of play: Health insurer changes have led to 6.5 million fewer prior authorizations, according to a survey of members by the trade group AHIP and Blue Cross Blue Shield released on Tuesday.
- Claim reviews decreased more than 15% in Medicare Advantage, they said.
- Major insurers including UnitedHealthcare, Aetna CVS Health and Kaiser Permanente last summer committed to reducing pre-treatment reviews, creating common electronic submission requirements and moving toward more real-time answers to review requests.
Zoom in: 65% of providers surveyed this year by Aetna agreed that prior authorization has a legitimate role to play in the health system, according to new results provided exclusively to Axios.
- But less than half (44%) said their current payers prioritize patient well-being and clear information, and just 36% believe insurers follow through on their promises.
- "I'm excited about the progress, but there's no question that we need to make more progress," Aetna president Steve Nelson told Axios.
Patient advocates still want new laws and regulations addressing prior authorization.
- "Voluntary commitments acknowledge the problem, but they are not a substitute for a solution in statute, with enforceable standards and accountability," Anthony Wright, executive director of Families USA, said in a statement.
- There's broad support in Congress to limit prior authorizations for Medicare Advantage, but the initiative has repeatedly stalled due to cost concerns.
What we're watching: Congressional Democrats released a report Wednesday morning on claim denials in employer-sponsored coverage that blames the Trump administration for not enforcing requirements that private insurers release claim denial data.
- "Without public disclosures of denial rates, group health plans and insurance companies are operating under a shroud of secrecy, allowing some to conduct arbitrary, improper, and mass claim denials without any accountability," says the report led by Rep. Bobby Scott (D-Va.), Ranking Member of the House Committee on Education and Workforce.
