You know when someone says they’re sorry only because they got caught?
That’s what it feels like with health insurers and prior authorization reform.
Even though some of the largest health insurance carriers are promising to cut back on prior authorization requirements (also known as “preapproval rules”), providers are skeptical.
That’s because insurers are seemingly only correcting course due to intensifying government scrutiny.
Here’s who’s on their best behavior:
- UnitedHealthcare announced it will eliminate nearly 20 percent of existing prior authorizations beginning in the third quarter for its commercial, Medicare Advantage, and Medicaid members in March.
- Cigna is set to eliminate prior authorization requirements for more than 600 procedures in its commercial plans, or 25 percent of its prior authorizations, in August.
- Blue Cross Blue Shield of Michigan promised to eliminate 20 percent of prior authorization requirements in September.
- Elevance Health, formerly known as Anthem, is automating and eliminating some prior authorizations, according to a CEO announcement in October.
But amid these changes, “providers question whether these new policies will actually reduce administrative burden or if insurers are mostly engaged in a public relations campaign to forestall government intervention,” according to an October 16 article in Modern Healthcare.
Don’t be fooled — there’s always a loophole for insurers. For instance, after UnitedHealth Group announced it would eliminate 20 percent of its prior authorizations in the spring, the very next day, the nation’s largest insurer said it would require additional pre-certifications for some oncology and outpatient surgical procedures.
What’s more, the article alleges that the “modifications” these insurers are making don’t even apply to the common services for which patients would typically need prior authorizations.
So, just what are federal authorities doing to crack down on insurers?
In July, the Departments of Health and Human Services, Labor, and Treasury proposed a rule aiming to restrict prior authorizations for mental health and substance abuse services among individuals with employer and government-sponsored health benefits. And in April, the Centers for Medicare and Medicaid Services (CMS) finalized a rule restricting prior authorizations under Medicare Advantage. In 2022, CMS proposed a rule to create an electronic system for processing prior authorization requests and to shorten wait times under Medicare Advantage, Medicaid, and exchange plans.
Maybe because of this increased government scrutiny, insurers feel the need to make good before they’re hit with even more regulations or fines. But just how long will they fight fair?
We’ll see how long this “good behavior” from insurers lasts.
