A coalition from health insurance companies undertakes to make changes to the pre -mandate process, after years of patient complaints and service providers about a system they say Delay And people’s troops are healthy.
On Monday, Federal Health officials met representatives from some of the country’s main insurance companies, including AETNA, Blue Cross Blue Shield Association, Cigna, Kaiser Permanente, and UNITEDHEALTHCARE. The Insurance Companies Alliance has voluntarily pledged to simplify the process that was widely criticized.
Insurance companies, as well as the Minister of Health and Humanitarian Services, Robert F. Kennedy Junior, Director of Medicare & Medicaid Services, Dr. Mohamed Oz, distributed commitment as a step towards improving the country’s health care system.
But this is not the first time that insurance companies have pledged to fix the process in recent years, as it attracted severe criticism.
Here is what to know about the prior mandate, and what insurance companies have pledged to do.
What is pre -mandate?
Pre -mandate indicates how long does medical service providers must obtain approval from insurance companies before performing the service.
Why is it very controversial?
Patients and service providers have criticized insurance companies for rejecting pre -authorization requests, saying that doing this prevents or delays patients from accessing the care of their doctors.
Nearly one of every three doctors reported that pre -authorization requests are repeatedly rejected or always, and about 75 % said that the number of denial has increased to some extent or significantly over the past five years, according to 2024. reconnaissance It was conducted by the American Medical Association. The survey found that about 93 % of doctors reported that the prior mandate had delayed access to the necessary care, and 82 % said that the process, at least sometimes, leads to completely abandoning treatment. More than one in four doctors responded to the survey that the operation led to a serious negative event for a patient who was treating him.
Read more: What do you do when health insurance denies the care you really need
the Deadly shooting In December, CEO of UNITEDHELTHARECACE Brian Thompson, who was on his way to an investor meeting in New York at the time of the attack, occupied the national headlines and drew attention to the controversy surrounding the previous license.
geese He said During a press conference, there was “violence in the streets on these issues”, in a clear indication of the shooting.
“This is not something negatively acceptable – the Americans are upset with it,” said Oz.
Insurance companies promised to fix the process before
Health insurance companies have made promises similar to the renovation of prior mandate in the past – in both 2018 and 2023Some insurance companies pledged to improve the process. But experts criticize Companies for their failure to make major changes.
UNITEDHEALTHCARE He said This, this year, will aim to reduce the total number of services that require almost 10 %.
In February, Cigna committed To make a number of changes to the operation, such as announcing plans to invest in resources that will help more patients solve problems related to pre -licensing faster, as well as simplifying the doctors’ process to submit applications.
What do they adhere to now?
According to press release From the Ministry of Health and Humanitarian Services (HHS), the alliance of health insurance companies is committed on Monday with six reforms:
- Unification of prior electronic presentations
- Reduce the number of medical services that require prior permission by January 1, 2026
- Honoring the current licenses while turning patients into another insurance plan to ensure that continuous care
- Improving transparency and communication with regard to delegation and appeal decisions
- Decreased delay by expanding approvals in the actual time for most requests by 2027
- Make sure medical professionals review all the denial of clinical care and services
What does RFK Jr say. And Dr. Oz?
Kennedy thanked insurance companies who pledged to make reforms.
“The Americans should not negotiate with their insurance company to obtain the care they need,” he said in the press statement. “The movement of patients and their doctors against mega companies was not good for anyone. We are actively working with the industry to facilitate obtaining prior permission for common services such as diagnostic photography, physiotherapy and outpatient surgery.”
Oz said in a press statement from HHS, with a reference to the feelings of Americans who are escalating towards this process, that the commitment from insurance companies was “a step in the right direction towards restoring confidence, alleviating burdens on service providers, and helping patients to obtain timely evidenced care.”
