5 Takeaways From Health Insurers’ New Pledge To Improve Prior Authorization

June 27, 2025

The largest U.S. health insurers have voluntarily agreed to streamline their prior authorization systems, following increased scrutiny after an insurance CEO's fatal shooting in December. Companies including Cigna, Aetna, Humana, and UnitedHealthcare pledged to reduce procedures requiring preapproval, expedite reviews, use clearer communication with patients, and ensure medical professionals review coverage denials. While CMS Administrator Mehmet Oz acknowledged the pledge is not mandatory, he indicated the government would intervene with regulations if insurers don't follow through on these commitments.

Who is affected

Most Americans with commercial/private coverage, Medicare Advantage, and Medicaid managed care
Patients who switch insurance plans (will have 90-day continuity of care)
Doctors and medical providers who deal with prior authorization requirements
Insurance companies (including Cigna, Aetna, Humana, and UnitedHealthcare)
Patients who face delays or abandoned treatment due to prior authorization processes

What action is being taken

Insurance companies are agreeing to make fewer medical procedures subject to prior authorization
Insurers are pledging to speed up the review process for prior authorizations
Companies commit to using clearer language in communications with patients
Insurers promise that medical professionals will review coverage denials
CMS is planning to post a list of participating insurers this summer
Insurers agree to post data about prior authorization use on a public dashboard

Why it matters

Prior authorization can force patients to delay or abandon necessary medical care
The current system has "reached a fever pitch" with serious consequences, including the fatal shooting of a UnitedHealthcare CEO
Insurance companies have a reputation problem they are trying to address
The voluntary pledge may help insurers avoid more stringent government regulation
The changes could potentially improve patient access to needed procedures like knee arthroscopy, vaginal deliveries, colonoscopies, and cataract surgeries
Patients switching insurance plans would have continuity of care for 90 days

What's next

CMS will post a full list of participating insurers this summer
Other details about the program will become public by January
Insurers have agreed to issue 80% of prior authorization decisions "in real-time" by 2027
Patient advocates are identifying "low-value codes" that should not require preapproval
The government may intervene with regulations if insurers don't make sufficient improvements

Read full article from source: The San Diego Voice & Viewpoint