Prior authorizations fell after insurer pledges, survey finds

A survey from AHIP and Blue Cross Blue Shield found about 6.5 million fewer prior authorizations after major insurers pledged to reduce pre-treatment reviews; claim reviews in Medicare Advantage fell more than 15%.

Health insurers' voluntary commitments last summer have been followed by a measurable drop in prior authorizations, industry groups report. AHIP and Blue Cross Blue Shield said members logged about 6.5 million fewer prior authorizations after major insurers pledged to reduce pre‑treatment reviews and standardize electronic submissions. Prior authorizations are used to control health care spending, but they can discourage patients from getting treatment and add administrative burden for providers. Provider surveys and patient advocates say the changes so far do not fully resolve concerns. Key findings: - AHIP and Blue Cross Blue Shield reported about 6.5 million fewer prior authorizations following insurer commitments. - Claim reviews in Medicare Advantage decreased more than 15%. - Major insurers including UnitedHealthcare, Aetna CVS Health and Kaiser Permanente committed to reducing pre‑treatment reviews, creating common electronic submission requirements, and moving toward more real‑time answers. - An Aetna survey found 65% of providers agree prior authorization has a legitimate role, while only 44% said current payers prioritize patient well‑being and clear information. - Only 36% of providers in the Aetna survey said insurers follow through on their promises. - Patient advocates call for statutory standards, and congressional efforts to limit prior authorizations in Medicare Advantage have repeatedly stalled over cost concerns. Summary: The decline in prior authorizations may ease some administrative burden for providers and reduce delays for patients, but provider confidence in insurer follow-through is limited. Patient advocates are pressing for enforceable rules, and congressional debate continues; further policy action is undetermined at this time.