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UnitedHealth Group and Cigna are revamping their prior authorization processes as new federal regulations aiming to ease the burden on providers and patients loom.
UnitedHealthcare will eliminate nearly 20% of existing prior authorizations beginning in the third quarter for its commercial, Medicare Advantage and Medicaid members, the insurer announced Wednesday. Next year, UnitedHealth will implement a national “gold card” program through which qualifying providers will simply notify the insurer about pending care rather than request prior authorization. This will eliminate the need for prior authorization in most case, according to the company.
UnitedHealth did not immediately respond to interview requests about why exchange plans were absent from these proposals, what procedures will be included, how it will determine eligibility for providers and how the notification process will work.
“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 make similar changes,” UnitedHealthcare Chief Medical Officer Dr. Anne Docimo said in a news release.
Cigna has removed prior authorization reviews for nearly 500 services and devices since 2020, Dr. Scott Josephs, national medical officer, wrote in an email. Approximately 6% of medical services are subject to Cigna’s prior authorization and the insurer uses an electronic process to enable fast responses to many requests, a spokesperson wrote in an email.
The health insurance lobbying group AHIP, Aetna, Centene, Elevance Health, Humana and Molina Healthcare did not immediately respond to interview requests.
Providers complain that prior authorization requirements have exploded in recent years, and that care is being delayed. For example, the Health and Humans Services Department’s inspector general reported last year that Medicare Advantage insurers improperly denied 13% of prior authorization requests.
The Centers for Medicare and Medicaid Services is slated to finalize proposals next month that would require health insurers to automate prior authorizations, process them more quickly, justify denials and publicly report data on their decisions.
This is a developing story. Please check back for updates.
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