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Several health insurers including UnitedHealthcare, Cigna, and Aetna are making plans to revamp their prior authorization processes. Prior authorization or preauthorization is when a doctor must get approval from an insurer for medication or treatment before administering it.
Changes are being made due to an impending federal rule which would limit the time insurers have to approve prior authorization requests. Starting in 2026, plans will respond to a standard request within 7 days (instead of the current 14-day period) and 72 hours for urgent requests. Doctors argue that the additional administration steps associated with preauthorization can delay necessary services and increase the administrative burden.
Changes
Many insurers plan to revamp their prior authorization processes by boosting automations and speeding up decision making. Insurers may review and assess utilization and may remove prior authorization reviews from some services.
Next Steps
The rule to streamline prior authorization processes is expected to finalize soon. Stay tuned to our blog for the latest updates. For now, employers can continue to monitor health care trends, utilization, and spending. Download the bulletin for more details.
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
