5 reactions to UnitedHealthcare's prior authorization cuts

Beginning this summer, UnitedHealthcare said it plans to eliminate 20 percent of its current prior authorizations and implement a national gold-card program. From medical groups to lawmakers who sponsored Medicare Advantage prior authorization reform legislation, here are five reactions to UnitedHealthcare's announcement:

Editor's note: Responses have been lightly edited for clarity and length. 

Rep. Suzan DelBene, D-Wash.:

The news that UnitedHealthcare and other private Medicare Advantage plans are finally reducing burdensome paperwork that is a regular barrier to seniors receiving the care they deserve is a step in the right direction. But seniors and their families shouldn’t be beholden to corporate goodwill. These changes should have been instituted long ago. The rules should be the same across Medicare Advantage and there needs to be greater transparency and accountability in the program. That’s why we must see today’s news as adding urgency to passing legislation that brings this archaic practice into the 21st century.

Gary Floyd, MD, Texas Medical Association President: 

The Texas Medical Association appreciates UnitedHealthcare’s plan to eliminate nearly 20 percent of current prior authorizations required of physicians. This action would improve timely care for patients.

A 2021 AMA survey found more than 90 percent of physician respondents reported care delays related to such requirements. Prior authorizations are a time-consuming process and contribute to physician burnout.  

Any effort to ease the burden on physicians and care for patients is a step in the right direction.

Anders Gilberg, Senior Vice President of Government Affairs, Medical Group Management Association: 

MGMA is appreciative of UHC’s plan to eliminate nearly 20 percent of their current volume of prior authorizations — a step in the right direction. Year after year, medical groups continue to report prior authorization to be the top regulatory burden they face. Onerous and ever-changing requirements force practices to divert resources away from delivering patient care. MGMA is supportive of gold-card policies that are effective in ensuring continuity of care and removing barriers for patients, and is hopeful that other health plans will soon follow suit. We look forward to seeing additional details surrounding UHC’s intended efforts to ease prior authorizations and encourage the company to seek stakeholder feedback on implementation and requirements so as to not unintentionally generate further disruptions and roadblocks to necessary patient care.

At the federal level, CMS must expeditiously finalize proposed policies surrounding prior authorization — revising standards for coverage, regulating the overall use of prior authorization, requiring transparency from health plans, shortening time frames for coverage decisions, and establishing electronic industrywide standards.

Rep. Mike Kelly, R-Pa.: 

It’s my hope that today’s announcement by UnitedHealth is the first of many announcements from commercial insurers about much-needed reforms to prior authorization. Americans, particularly seniors, deserve to receive timely access to care. Waiting days or weeks only to be denied a routine medical service can be crushing to a family. Decisions about health care should be between a patient and their doctor. Bureaucratic paperwork should never be a barrier.

Molly Smith, Group Vice President for Policy, American Hospital Association: 

While we have not yet seen the specifics of these efforts, cutting back on unnecessary prior authorization is a much-needed step forward. We will work with our members to carefully monitor plans’ implementation of these policies to ensure they do indeed remove unnecessary barriers to care for patients and wasteful administrative burden on providers. Meanwhile, we continue to urge policymakers to formalize their proposals to streamline the prior authorization process and other related policies.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months