Health Insurers Take Major Accountability Step On Prior Authorization

Most of the nation’s biggest health insurance companies, including Cigna, CVS Health’s Aetna, Humana and Elevance Health, are poised to ease prior authorization, the process of insurers reviewing hospital admissions and medications.

The change, expected to be announced as early as Monday by America’s Health Insurance Plans, also known as AHIP, and the Chicago-based Blue Cross Blue Shield Association, has been at the forefront of legislative efforts in Washington and state capitals across the country. A related announcement has been scheduled for Monday afternoon by members of the Donald Trump administration.

The health insurance industry’s effort to improve accountability, transparency and customer support also comes after an outpouring of public anger at the health insurance industry following the Dec. 4 UnitedHealthcare CEO shooting.

Doctors complain prior authorization has delayed needed treatment and put patient health in jeopardy while wasting physician time to jump through hoops while adding to physician burnout. Over the past several years, prior authorization increasingly has become a concern for patient access to needed services, according to almost 30% of physicians responding to an American Medical Association survey in 2023.

Health insurers involved in the effort say companies have agreed to streamline, simplify and reduce prior authorization, according to two health plans with knowledge of the changes.

Neither AHIP nor the Blue Cross Blue Shield Association would comment when reached Friday afternoon. AHIP represents some of the biggest names in health insurance including CVS Health’s Aetna, Centene, Cigna, Humana and Elevance Health. Blue Cross Blue Shield Association represents the nation’s largest Blue Cross and Blue Shield plans including Florida Blue and Health Care Service Corp., parent of Blue Cross and Blue Shield plans in five states, including Illinois and Texas.

Sources close to the effort from participating plans say the insurers are committed to the changes in all health plans that they sell including commercial coverage, Medicare Advantage for seniors and Medicaid health plans that they administer for low-income Americans via contracts with states.

The changes could benefit more than 250 million Americans, health plans involved say. Further details weren’t available Friday ahead of a more detailed announcement on Monday.

The effort is the latest and biggest so far among health insurers. Earlier this year, The Cigna Group announced a new multi-year effort to improve accountability.

Cigna’s announcement to launch “actions to drive positive change for customers and patients” came just days after company chief executive David Cordani addressed analysts and investors on the industry’s need to provide customers with more support and resources to navigate the healthcare system.

“In early December, we all witnessed the tragic murder of Brian Thompson, a leader at the UnitedHealth Group,” Cordani told analysts and investors on the company’s fourth quarter and full year 2024 earnings call. “The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry. At The Cigna Group, we are further accelerating improvements in innovations to increase transparency, expand support and drive even greater accountability.”

Cigna was the first rival of UnitedHealth Group’s UnitedHealthcare to roll out some reforms since the shooting in New York on the company’s annual investor day. Thompson’s death unleashed a barrage of scrutiny on health insurer denials of medical care and certain other business practices from social media trolls and industry critics including some in Congress who say they’d like to see reform.