April 2, 2023 – The largest health insurer in the United States says it will no longer require lengthy paperwork known as prior authorization for many types of health care starting later this year.
UnitedHealthcare made the announcement last week that it would trim prior authorizations by 20% amid growing calls from medical professionals, patients, and politicians that the process causes harmful treatment delays or denials.
“We’re not deaf to the complaints out there,” Philip Kaufman, chief growth officer at UnitedHealthcare, told The Wall Street Journal. “We’ve taken a hard look at ourselves and this process.”
The insurer also announced it would create a “gold card” program next year for pre-approved health care providers to skip prior authorizations for most procedures.
Other insurers, like Cigna and Aetna, have also announced changes such as automating or simplifying the prior authorization process, the Journal reported.
Prior authorization requires a health care provider to prove the need for a treatment, procedure, or medical device. This usually involves paperwork. The process typically takes a couple weeks or less but sometimes can stretch on for months. Many providers and hospitals employ staff to fill out the paperwork and send it to insurers.
More than 9 in 10 doctors report that prior authorizations have delayed a person’s access to necessary medical care, according to a survey of 1,001 doctors conducted by the American Medical Association. One in three doctors also said in the survey that the lengthy red tape harmed people, such as leading to hospitalization, a life-threatening event or a “disability or permanent bodily damage, congenital anomaly or birth defect, or death.”
Some in the medical community want the process completely eliminated.
“We all know that requiring prior authorizations really only leads to more bureaucracy within the insurance company, as well as within each healthcare provider's practice, because now we need people to fill out these prior authorization forms, waste time trying to get through their 1-800 number to speak with someone who has no clinical knowledge, then be told we need to speak with someone else who actually does have some medical knowledge about why these procedures are necessary. This thereby leads to increased costs because we all need to hire more people to handle these needless requests," Linda Lee, MD, medical director of endoscopy at Brigham and Women's Hospital in Boston and associate professor of medicine at Harvard Medical School, told Becker's ASC Review.