Why insurers are scaling back prior authorizations

September 07, 2023


Some health insurance companies are rethinking prior authorization amid a groundswell of complaints from patients and providers and intensifying government scrutiny.

Health insurance companies employ prior authorization rules to constrain costs and to limit unnecessary care, much as insurers place limits on coverage in other ways. Yet big players such as UnitedHealth Group, Cigna and several Blue Cross and Blue Shield companies have announced plans this year to relax their precertification policies. Provider groups have applauded these announcements, albeit cautiously.

Related: CMS prior authorization data rules in conflict, AHA, AMA, insurers say

According to providers, health insurance companies have imposed prior authorization requirements on an ever-increasing number of services and products in recent years, interfering with patient care and burying them in paperwork. In an American Medical Association survey last year, doctors reported they spend an average of 14 hours each week on prior authorization requests. Eighty-eight percent described the burden as high.

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