By I. Edwards HealthDay Reporter<\/b>
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WEDNESDAY, June 25, 2025 (HealthDay News) \u2014 Getting approval from your insurance company before a procedure or treatment may soon get a little easier.<\/p>\n
U.S. Health and Human Services Secretary Robert F. Kennedy Jr<\/a>. said this week that several of the nation\u2019s largest health insurers have agreed to change how they handle prior authorization, a system that often causes delays in care.<\/p>\n About 1 in 6 insured adults in the U.S. say they\u2019ve had trouble with prior authorizations, according to a recent survey from health policy group KFF.<\/p>\n Now, major insurers \u2014 including Blue Cross Blue Shield Association, Cigna, Elevance Health, GuideWell, Humana, Kaiser Permanente and UnitedHealthcare \u2014 say they\u2019ll take steps to fix the issue, NBC News <\/em>reported.<\/p>\n The changes will apply to people with private insurance, Medicare Advantage and Medicaid, Kennedy said.<\/p>\n An industry group called AHIP (formerly known as America\u2019s Health Insurance Plans) said the updates could help as many as 257 million people.<\/p>\n But experts say the changes may not go far enough.<\/p>\n It\u2019s \u201cgoing to streamline it in some incremental ways only,\u201d Dr. Adam Gaffney<\/a>, a critical care doctor and assistant professor at Harvard Medical School, told NBC News<\/em>.<\/p>\n Insurance companies have promised changes like these before, in 2018 and 2023, but many didn\u2019t follow through, Dr. Mehmet Oz<\/a>, head of the Centers for Medicare & Medicaid Services (CMS), said.<\/p>\n When asked what\u2019s different this time, Oz referred to the fatal shooting of a top UnitedHealthcare executive last year, calling it a sign of growing public frustration.<\/p>\n \u201cThere\u2019s violence in the streets over these issues,\u201d Oz said.<\/p>\n AHIP previewed some of the coming changes.<\/p>\n Starting next year, if a patient switches insurance plans while getting treatment, the new plan must honor the old plan\u2019s prior authorization for at least 90 days.<\/p>\n Insurers must provide clearer explanations when care is denied and explain how patients can appeal.<\/p>\n Medical professionals will be required to review all denials (though insurers say they already do this).<\/p>\n By 2027, at least 80% of electronic prior authorization requests will be answered in real time, and the process will be easier to do online.<\/p>\n Some plans may also cut back on the number of procedures that need prior approval in certain areas, although specific examples weren\u2019t shared.<\/p>\n CMS said it hopes insurers will stop requiring prior authorizations for common things such as colonoscopies, cataract surgery and childbirth.<\/p>\n Officials are also working to improve access to physical therapy, diagnostic imaging and outpatient surgery.<\/p>\n Still, some experts remain skeptical.<\/p>\n \u201cTalk is cheap,\u201d Gaffney said. \u201cMore fundamental reform will be needed to address the ubiquitous barriers to care imposed by insurance firms.\u201d<\/p>\n More information<\/strong><\/p>\n Harvard Health has more on prior authorization<\/a>.<\/p>\n