Washington Minister of Health and Human Services Robert F. Kennedy Jr. said on Monday that the country’s largest health insurers have promised to take steps to optimize a frequently criticized preliminary permit that can delay or refuse patients’ access to care.
The previous permit is a cost reduction tool used by health insurers, which requires them to give up tests, procedures or medicines before patients receive them.
The insurance tactics attracted attention last year after the fatal shooting of Brian Thompson, CEO of UNITEDHEALT’s insurance arm, in New York.
Patients and doctors say the previous permission creates too many obstacles, forcing people to wait days or weeks for the necessary treatments or to refuse them completely.
About 1 in 6 insured adults say they had previous resolution problems, according to a KFF study, a health policy study group.
Kennedy said a number of major insurance companies – including the Blue Cross Blue Cross, Cigna, Elevance Health, Guadewell, Humana, Kaiser Perente and UNITEDHEATOID – have promised to make the changes that will be realized in private insurance, Medic, Medic, Medic.
AIP, a health insurance commercial group, said the changes could benefit from 257 million people in the United States.
However, the experts stressed that the preliminary permit did not disappear.
This will only optimize it in some gradual ways, “says Dr. Adam Gafni, a doctor and an assistant in critical care at the Harvard Medical School.
Health insurance companies have made similar commitments to determine the preliminary permission in the past, a fact that Kennedy and Dr Mehmet Oz, administrator of the Medicare & Medicaid Services (CMS) centers recognized at a media event on Monday. In 2018 and again in 2023, health insurance companies made commitments to reform preliminary permission, Oz said, but many failed to implement such reforms.
Asked what is different this time, he said, “There is violence on the streets on these problems,” hinting at Thompson’s shooting.
AIP – a former American health insurance plans – described in detail the steps of health insurance companies involved in a news message earlier on Monday.
From next year, if patients switch insurance plans while receiving treatment, their new plans will honor the existing previous permits for such care up to 90 days. In addition, next year, insurers will have to provide easier to understand explanations when refusing permissions and offering guidance on how to appeal.
Insurers have promised medical professionals to review all the refusals of permission, although AIP said it is something that insurers say they are already doing.
Insurers are also committed to optimizing the pre -authorization process by facilitating requests online by 2027. At least 80% of the electronic requests will be answered in real time by 2027, AIP reported.
Plans can also reduce the number of medical services subject to previous permits in certain cities or countries – although specific commitments to what may include.
Chris Klop, who runs the Medicare program at CMS, said the agency would like insurers to return previous requirements for a common services permit, including colonoscopies, cataract surgery and childbirth.
Kennedy also said CMS works with insurers to make it easier to obtain a preliminary permission for diagnostic image, physical therapy and outpatient surgery.
Gafni criticized the promises, saying that insurers had had decades to change their practices.
“The conversation is cheap,” Gafni said. “A more fundamental reform will be needed to deal with the ubiquitous care barriers imposed by insurance companies.”
Kaye Pestaina, director of the KFF patients and users, said some of the commitments may have a direct impact on patients, such as worshiping existing previous permits for three months after switching insurers.
This article was originally published on nbcnews.com