UnitedHealthcare, Cigna prior authorization cuts not to be confused with major progress: AMA

UnitedHealthcare and Cigna's prior authorization cuts are steps in the right direction, but the American Medical Association is "careful not to confuse positive developments with major progress," the organization's immediate past president Jack Resneck, MD, said. 

"Prior authorization remains a major obstacle to timely and necessary care for our patients and an overwhelming burden to physicians," Dr. Resneck said in a Sept. 18 article on AMA's website. 

UnitedHealthcare on Sept. 1 started the first wave of its previously announced plan to cut prior authorizations by 20 percent. Cigna said in late August that it removed prior authorization requirements for more than 600 medical procedures, cutting the number of prior authorizations it requires by 25 percent. 

While the AMA said it is cautiously optimistic that the changes will lead to reduced burdens, the changes come only after years of "apathetic or ineffectual follow-through by health insurers on mutually accepted prior authorization reforms, with many other insurers failing to make the agreed upon changes."

The AMA expressed skepticism toward UnitedHealthcare's recent implementation of an advance-notification program for nonscreening gastroenterology endoscopies. The program was put in place after UnitedHealthcare backed off of a new prior authorization policy set to take effect June 1 following pushback from GI Societies and other medical organizations. 

 "While the program only requests that physicians submit supporting documentation to the insurer and does not result in medical necessity denials, it still increases administrative hassles for practices," the AMA said in the article. "Moreover, UHC will be using the data from this program to determine eligibility for its gold-carding program in 2024 — suggesting that these endoscopy services may be added to the insurer’s prior authorization list."  

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