What UHC And Cigna Are Doing To Reduce Prior Authorization Delays

Two of the largest health insurers in the country, UnitedHealthcare (UHC) and Cigna Healthcare, have announced plans to reduce the number of medical services that require prior authorization, a practice that often delays patient care and burdens physicians.

Prior authorization requirement details

• UHC said it will eliminate prior authorization for many procedure codes that account for nearly 20% of its overall prior authorization volume, starting this month. It also said it will launch a “gold card” program next year that will allow some providers to follow a simpler notification process instead of prior authorization for most procedure codes.
• Cigna said it will remove nearly 25% of medical services from prior authorization requirements, cutting more than 600 codes.

Physician reaction

The American Medical Association (AMA) welcomed the insurers’ efforts as a “step in the right direction” and in line with a consensus statement to improve the prior authorization process that was agreed to by insurers in 2018. The AMA’s Immediate Past President Jack Resneck, MD, said he was “cautiously optimistic” that patients and physicians will feel some relief from the prior authorization burden under these plans.

However, Dr. Resneck also said that the AMA is “careful not to confuse positive developments with major progress,” noting that prior authorization remains a major obstacle to timely and necessary care and an overwhelming burden to physicians. He cited UHC’s recent implementation of an advance-notification program for non-screening gastroenterology endoscopies as an example of a policy that still increases administrative hassles for practices and may lead to more prior authorizations in the future.

Prior authorization impact

The insurers’ announcements come after years of lackluster follow-through by health insurers on mutually accepted prior authorization reforms, with many other insurers failing to make the agreed upon changes, as shown in the most recent AMA survey of physicians. The survey also found that prior authorization leads to unnecessary waste and avoidable patient harm, with one-third of the 1,001 physicians surveyed reporting that prior authorization has led to a serious adverse event for a patient in their care.