UnitedHealthcare , Kaiser Permanente and other major U.S. health insurers say they want to make it faster and easier for patients to obtain care.
Health Insurance Plans (AHIP), a trade association that represents the health insurance industry, announced Monday that some of its biggest members are taking steps to streamline « prior authorization » — industry jargon for the process by which health care providers obtain approval from patients’ insurance carriers to deliver care.
Prior authorization requests can be time-consuming for doctors, resulting in frustrating delays for patients in obtaining essential medical care. According to a survey from the American Medical Medical Association, physicians’ offices spend an average of 12 hours per week seeking approval for services from insurers, administrative hurdles that critics say takes time away from providing care.
As part of the new agreement, participating insurers have committed to a series of steps they say will speed up the sluggish process. That includes creating a standardized system for submitting prior authorization online, reducing the amount of claims subject to prior authorization and ramping up real-time responses to requests. Such changes are scheduled to take effect in 2026 and 2027.
« The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike, » AHIP CEO Mike Tuffin said in a statement. « Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system. »
Shawn Martin, CEO of the American Academy of Family Physicians, said in a statement that the insurance industry initiative is a « step in the right direction, » but that the real test will be the impact it has on the experiences of patients and physicians.
Dozens of insurers signed onto the commitment, including a number of state Blue Cross and Blue Shield plans and some Medicare and Medicaid plans. In all, AHIP says the joint effort to improve prior authorization could benefit more than 250 million Americans.
The signatories include:
- AmeriHealth Caritas
- Arkansas Blue Cross and Blue Shield
- Blue Cross of Idaho
- Blue Cross Blue Shield of Alabama
- Blue Cross Blue Shield of Arizona
- Blue Cross and Blue Shield of Hawaii
- Blue Cross and Blue Shield of Kansas
- Blue Cross and Blue Shield of Kansas City
- Blue Cross and Blue Shield of Louisiana
- Blue Cross Blue Shield of Massachusetts
- Blue Cross Blue Shield of Michigan
- Blue Cross and Blue Shield of Minnesota
- Blue Cross and Blue Shield of Nebraska
- Blue Cross and Blue Shield of North Carolina
- Blue Cross Blue Shield of North Dakota
- Blue Cross & Blue Shield of Rhode Island
- Blue Cross Blue Shield of South Carolina
- BlueCross BlueShield of Tennessee
- Blue Cross Blue Shield of Wyoming
- Blue Shield of California
- Capital Blue Cross
- Capital District Physicians’ Health Plan, Inc. (CDPHP)
- CareFirst BlueCross BlueShield
- Centene
- The Cigna Group
- CVS Health Aetna
- Elevance Health
- Excellus Blue Cross Blue Shield
- Geisinger Health Plan
- GuideWell Mutual Holding Corporation
- Health Care Service Corporation
- Healthfirst (New York)
- Highmark Inc.
- Horizon Blue Cross Blue Shield of New Jersey
- Humana
- Independence Blue Cross
- Independent Health
- Kaiser Permanente
- L.A. Care Health Plan
- Molina Healthcare
- Neighborhood Health Plan of Rhode Island
- Point32Health
- Premera Blue Cross
- Regence BlueShield, Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Asuris Northwest Health, BridgeSpan Health
- SCAN Health Plan
- SummaCare
- UnitedHealthcare
- Wellmark Blue Cross and Blue Shield
