Reed Abelson reports for The New York Times on a health insurance company voluntary pledge to improve the prior authorization process for working people, as well as people with Medicare and Medicaid. For at least the next two years, people will continue to face the likelihood of inappropriate delays and denials of care as a result of insurers’ prior authorization requirements. It appears that the insurers are not committed to meaningful change before 2027.
The Trump administration needs to regulate the prior authorization process in Medicare Advantage. As it is, endless reports from independent organizations and government agencies reveal widespread abuses among health insurers in Medicare Advantage. They overbill taxpayers for their services; they keep their enrollees from seeing high quality specialists and using good hospitals; they arbitrarily delay and deny care; all in pursuit of higher revenue and profits for their shareholders.
Whatever the insurers end up doing voluntarily, they can stop doing, as they please. We know from UnitedHealthcare that they can turn on and off the prior authorization spigot, when they think they need to do so. How is it that it will take them two years to respond to prior authorization requests in real time, and, then, only 80 percent of them?
We need CMS to implement standardized evidence-based prior authorization rules. Without them, people end up enrolling in Medicare Advantage plans that indiscriminately delay and deny needed care, endangering their health and well-being. We know from the HHS Office of the Inspector General that inappropriate use of prior authorization is widespread. Medicare Advantage enrollees who develop complex conditions can be at serious risk.
Insurers have provided no evidence that they use prior authorization to rein in health care costs for the good of their enrollees, although that’s their claim. In fact, unions often push their retirees into Medicare Advantage plans with fewer prior authorization requirements; they simply pay the insurers more to avoid some of these requirements.
Prior authorization is an easy way for insurers to keep more premium dollars for themselves.
Here’s more from Just Care:
- OIG finds widespread inappropriate care denials in Medicare Advantage
- OIG finds Medicare Advantage continues to overcharge government
- Insurer provider directories misleadingly include physicians who are out of network
- Oncologists report excessive deaths from prior authorization
- New physician survey finds prior authorization harms cancer patients
