UnitedHealthcare To Cut Prior Authorization Usage By 20%
UnitedHealthcare plans to cut back on its use of prior authorization, removing procedures and medical devices from its list of services requiring signoff and reducing the number of authorizations from 13 million to 10 million annually, according to a March 29 report from The Wall Street Journal.
Several procedures and devices will be removed starting in the third quarter. The insurer also plans to automate and speed up prior authorization over the next several years, according to the report.
Next year, the insurer will also eliminate several prior authorization requirements for its "gold-card" physicians and hospitals, or those who nearly always get their requests approved.
Other insurers, including the Cigna Group and CVS' Aetna, are removing prior authorization requirements and automating the process as well.
While insurers claim that prior authorization tamps down costs and helps patients get the best care, physicians argue that the process is time-consuming and ineffective.
According to a March study from the American Medical Association, prior authorization has delayed patient care for 94 percent of physicians.
"We all know that requiring prior authorizations really only leads to more bureaucracy within the insurance company, as well as within each healthcare provider's practice, because now we need people to fill out these prior authorization forms, waste time trying to get through their 1-800 number to speak with someone who has no clinical knowledge, then be told we need to speak with someone else who actually does have some medical knowledge about why these procedures are necessary. This thereby leads to increased costs because we all need to hire more people to handle these needless requests," Linda Lee, MD, medical director of endoscopy at Boston-based Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, told Becker's.
"We're not deaf to the complaints out there," Philip Kaufman, chief growth officer at UnitedHealthcare, told The Wall Street Journal. "We've taken a hard look at ourselves and this process."
Last year, the Department of Health and Human Services reported that 13 percent of prior-authorization denials by Medicare Advantage plans were for benefits that should have been covered, according to the report.
United has yet to specify what services will be affected by the change but suggested they will include certain types of medical equipment and genetic testing used for diagnosis.
UnitedHealthcare, Cigna, Aetna Revamping Prior Authorization Ahead Of CMS Rule
UnitedHealthcare announced on Wednesday that it will reduce the use of its prior authorization process by 20% for some non-urgent surgeries and procedures.
The reductions will begin in the third quarter and continue through the rest of the year for most commercial, Medicare Advantage and Medicaid businesses. Cigna and Aetna also are making moves to revamp their prior authorization processes, according to The Wall Street Journal.
"Prior authorizations help ensure member safety and lower the total cost of care, but we understand they can be a pain point for providers and members," said Dr. Anne Docimo, chief medical officer for UnitedHealthcare. "We need to continue to make sure the system works better for everyone, and we will continue to evaluate prior authorization codes and look for opportunities to limit or remove them while improving our systems and infrastructure. We hope other health plans will make similar changes."
The move comes ahead of a Centers for Medicare & Medicaid Services rule expected to be finalized soon that would limit the amount of time insurers have to approve prior authorization requests. In December, the federal government proposed several changes that would force health plans, including Medicaid, Medicare Advantage and Affordable Care Act marketplace plans, to speed up prior authorization decisions and provide more information about the reasons for denials. Starting in 2026, it would require plans to respond to a standard prior authorization request within seven days instead of the current 14 and within 72 hours for urgent requests. The proposed CMS rule was scheduled to be open for public comment through mid-March.
UnitedHealthcare plans to implement a national gold card program early next year for providers that meet eligibility requirements, which would eliminate prior authorizations for most procedures. The company also said it will deploy a range of initiatives over the next several years, aligned with the most recent guidance from the CMS, creating an enhanced prior authorization experience through improved automation and faster decision making.
The majority (94%) of physicians reported that prior authorization led to delays in patient care and has caused increased administrative burden, a recent survey from the American Medical Association found.
UnitedHealthcare To Cut 20% Of Prior Authorizations
UnitedHealthcare (NYSE:UNH) announced Wednesday that it plans to eliminate the use of nearly 20% of current prior authorizations, a decision that will benefit healthcare providers and patients who have long complained about the cumbersome process.
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Also known as preauthorization, prior authorizations require health care providers to obtain coverage approvals from health plans before conducting certain non-emergency medical procedures.
The company said the decision would take effect from Q3 2023 and continue through the year for most Commercial, Medicare Advantage, and Medicaid businesses.
UnitedHealthcare (UNH) also announced the launch of a new program under which eligible care provider groups can cut prior authorization requirements from early 2024.
The national Gold Card Program will allow participating provider groups to follow a simple notification process instead of the prior authorization for most procedures.
"Prior authorizations help ensure member safety and lower the total cost of care, but we understand they can be a pain point for providers and members," chief medical officer of UnitedHealthcare (UNH) Dr. Anne Docimo said.
"We need to continue to make sure the system works better for everyone, and we will continue to evaluate prior authorization codes and look for opportunities to limit or remove them while improving our systems and infrastructure. We hope other health plans will make similar changes."
According to The Wall Street Journal, which first reported the move, CVS Health's (CVS) insurance unit Aetna has also said that the company aims to automate and simplify prior authorization. Cigna (CI) was also dialing down on prior authorization, trimming the requirement for about 500 services and devices since 2020.
Read: Seeking Alpha contributor George Fisher argues that UnitedHealthcare (UNH) is a 4 for 1 winner given its diversified business spanning from health insurance to healthcare analytics.
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