In a big win for patients, dozens of health insurers – including UnitedHealthcare and CVS Health’s Aetna – plan to reduce the number of healthcare claims that require prior authorization. This move will be transformative for patients who often endure long delays in coverage of essential medical care.
Prior authorization means health insurers require approval before they cover medical care, prescription, or other services. The purpose of this authorization is to guard against the overuse of certain care and to ensure that correct treatment is provided to patients. But over time, the practice has expanded, becoming unnecessarily complex and time intensive.
Dr. Mehmet Oz, who oversees the Centers for Medicare and Medicaid Services, says that “insurers are motivated to make something stick this time around” and find a solution to the delays in authorization. The insurers who are committed to improving their systems say that they will standardize the electronic prior authorization process by the end of 2026. Part of that plan is to reduce the number of claims in need of authorization while also honoring the pre-approvals from previous employers. Another part of the plan is to “expand the number of real-time responses” to claims and “ensure that claims denied for clinical reasons will continue to be reviewed by medical professionals.”
As a result, many patients will no longer have to worry about delays in approval that cause their diseases and conditions to progress untreated. Countless patients who want to know whether important test results in a timely manner will not be able to access that information sooner.
Solidarity HealthShare has long provided our Members with this peace of mind regarding coverage for their medical conditions using our Health Sharing model to facilitate affordable access to ethical healthcare. And for this reason, we are delighted to hear that traditional providers are recommitting themselves to deliver the best, most timely coverage possible.
To learn more about how you and your family can access affordable care through our program, give us a call today at work (737) SHARING.