AP Health Writer, Tom Murphy
The country’s leading health insurance companies are committed to reducing and improving widely diminished practices that lead to delays in care and complications.
UnitedHealthcare, CVS Health’s Aetna and dozens of other insurers say they plan to reduce the scope of medical claims eligible for advance permits, standardize some of the process, and expand responses made in real time.
Pre-approval means that an insurance company requires approval before covering services such as medical, prescription, or imaging trials. Insurance companies say they do this to prevent overuse of care and ensure patients get the right treatment.
However, doctors say the practice grows into scope and complications, leading to frequent delays in care. The fatal shooting of United Healthcare CEO Brian Thompson in December prompted many to vent their frustration with issues of press such as pre-approval.
Dr. Mehmet Oz was called “Pox on the System” hiking administrative costs during a Senate confirmation hearing in March to lead the Centers for Medicare and Medicaid Services.
The insurance company said Monday that it will standardize electronic pre-authorization by the end of next year to help speed up the process. They cut down the scope of claims covered by medical advance permits and respect the previous insurance company’s pre-approval for a set of times after someone has switched plans.
They also plan to expand the number of real-time responses and ensure that medical reviews are conducted for rejected requests.
Researchers say advance permitting has become more common as care costs have risen, especially for prescription drugs, lab testing, physical therapy and imaging testing.
“We’ve been working hard to get into the world,” said Michael Anne Kyle, an assistant professor at the University of Pennsylvania.
Almost every customer of the Federal Government Medicare Advantage Plan personally running Medicare programs requires prior approval of some services, particularly expensive care, such as hospital stays. The survey also found that the insurance company rejected about 6% of all requests.
Dr. Ashley Schmral of Charlotte, North Carolina says there is an increase in previous approvals required for routine examinations such as MRI. Sumrall, an oncologist who treats brain tumors, said these images are important for doctors to determine if treatment is working and plan their next steps.
Doctors say delays from a final approved request or refusal to compensate can hurt patients by giving them time for disease progressing without treatment. They can also spike the anxiety of patients who want to know if the tumor is stopping growth and whether insurance covers scans.
There’s a term called “scanxiety,” and that’s very realistic,” said Sumrall, a member of the Association of Volunteer Leadership in Clinical Oncology.
Different forms and different pre-authentication policies also complicate the process. Sumrall said that every insurance company has “a unique way of doing business.”
“For years, companies didn’t want to compromise, so I think a step in the direction of standardization would be encouraging,” she said.
Insurers say their commitments apply to compensation through work and individual markets, Medicare Advantage Plans, and state and federally funded Medicaid programs.
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Original issue: June 23, 2025 9:36am EDT
