by Some of the country’s largest insurance providers promise to carry out essential reforms of the previous approval process, a practice in which the insurance company takes care of certain treatments that contribute to the delayed or broken care of millions of Americans every year.
“The Americans should not have to negotiate with their insurer to receive the care they need,” said Robert F. Kennedy Jr., secretary for health and human services, on Monday and announced the changes at a meeting of insurance groups in Washington. “Patients and their doctors against massive companies were good for anyone.”
The assembled companies include changes that work towards a standardized system of earlier authorization requests for electronic authorization; Reduction of the number of treatments that are subject to prior approval; Awarding of existing permits during insurance transitions; and expansion of reactions in real time on authorization inquiries with the aim of real -time decisions for most inquiries by 2027.
“There are violence on these questions in the streets,” said Dr. Mehmet OZ, administrator of Medicare and Medicaid Services, in the forum, an obvious reference to the fatal shootout of the CEO of Unitedhealthcare Brian Thompson in December. “This is no longer a passively accepted reality – the Americans are upset about it.”
Representatives of large non -profit groups such as Aetna, Blue Cross Blue Shield, Centene Corporation, Cigna, Elevance Health, Guideewell, Highmark Health, Humana, Emperor Permanent and Unitedhealthcare were present on the roundtable.
AHIP, the largest lobby group in the health insurance industry, praised the reforms.
“The health system remains fragmented and burdened by outdated manual processes, which leads to frustrations for patients and providers,” said AHIP President Mike Tuffin in an explanation. “Health plans use voluntary obligations to achieve more seamless patient experience, and enable providers to concentrate on patient care and at the same time modernize the system.”
Some were skeptical that the voluntary reforms would ultimately give more Americans access to care, especially in view of the attempts by the Trump administration, medicaid and projections that show that the so-called “large, beautiful bill” cancellation in the next 10 years could lead to $ 793 billion in the next 10 years with 10.3 million fewer people on medicaid on medicaid.
“We know from research that Medicaid’s work requirements generate insurance losses without creating appropriate employment increases,” Miranda Yaver, Professor of Health Policy at the University of Pittsburgh and author of the upcoming book Coverage rejected: How health insurers drive inequality in the United Statessaid npr.
“I don’t think it would be unfair to say that we replace a set of stress with another,” she added.
A 2023 KFF survey showed that earlier authorization problems influence a large number of Americans, especially those with the greatest medical needs.
Almost a third of adults who had more than 10 visits to a doctor in the course of this year reported on previous approval problems, while adults had at least one prescription medicine more than twice the problems that do not.
The American Medical Association describes the previous approval system as a “over -claimed, costly, inefficient, opaque and responsible for delays in patient care”. Due to his survey data, more than nine out of ten doctors are reported that the insurers are waiting for the insurers to approve the necessary care.
