Core Concepts
Lawmakers in multiple states are introducing bills to address the challenges posed by health insurers' prior authorization practices and improve patient care.
Abstract
The content discusses the growing criticism of health insurers' prior authorization practices and the legislative efforts in 30 states to address these issues. It highlights the challenges faced by physicians, the federal and state-level initiatives to streamline prior authorizations, and the responses from major insurers like United HealthCare, Cigna, and Aetna CVS Health. The article also delves into the opposition from the insurance industry, the introduction of gold card legislation in various states, and the potential impact of these reforms on patient care and physician practices.
Highlights:
- Lawmakers in 30 states introduce bills to rein in health insurers' prior authorization practices.
- Federal efforts to streamline prior authorizations for Medicare patients face challenges.
- Major insurers like United HealthCare, Cigna, and Aetna CVS Health announce plans to reduce prior authorization requirements.
- States like Maryland, Washington, DC, and New Jersey propose comprehensive reform bills to address prior authorization issues.
- Gold card legislation introduced in several states aims to exempt high-performing physicians from prior authorizations.
- Challenges and limitations of prior authorization reforms are discussed, including the impact on physician eligibility for gold card status.
Stats
Last year, Congress failed to pass the Improving Seniors' Timely Access to Care Act of 2021, despite 326 co-sponsors.
United HealthCare plans to eliminate almost 20% of its prior authorizations for nonurgent surgeries and procedures starting this summer.
Cigna has removed prior authorization reviews from nearly 500 services since 2020.
California is one of about a dozen states that have introduced gold card legislation this year.
The Texas Department of Insurance estimated that only 3.3% of licensed physicians in the state have met "gold card" status since the bill became law in 2021.
Quotes
"This is something that goes on in every doctor's office every day; the frustrations, the delays, and the use of office staff time are just unbelievable." - Steven Orland, MD
"These are important reforms that will help ensure that patients can receive the care they need, when they need it." - CMA president Donaldo Hernandez, MD