United Healthcare, the nation’s biggest insurer, just announced that it’s cutting back on prior authorization requirements by 30%. Other insurers have been doing this in the last year, too.
Prior authorization is intended to reduce costs and prevent people from getting expensive, unnecessary care. It’s when your insurer has to approve certain tests, procedures, or treatments that your doctor has ordered before you can get them.
If you have a chronic health condition, you’re probably quite familiar with prior authorization.
Amy Killelea, an assistant research professor at Georgetown's Center on Health Insurance Reforms, has done a lot of research on coverage for diabetes, “and I will say, continuous glucose monitors are often — if not predominantly — covered with prior authorization attached to them.”
Lots of other durable medical equipment prescribed by a doctor often requires insurer approval, too, like insulin pumps and wheelchairs. That’s the case, as well, with certain surgeries, many prescription drugs and therapies, and imaging tests like MRIs.
In polling people with chronic illnesses, “after cost, they say that prior authorization is the biggest administrative hassle they have,” said Kaye Pestaina, who directs the Program on Patient and Consumer Protections at the health policy nonprofit KFF.
It’s also increasingly an issue even for people who don’t have a chronic illness. Pestaina said that’s likely why there’s growing pressure for something to change.
“It's coming at a time where costs are going up, people are signing up for coverage, and then realizing that something that they need, the care they need is not being covered,” she said.
Soon, UnitedHealthcare said it will no longer require prior authorization for certain outpatient surgeries and therapies, some diagnostic tests like echocardiograms, and chiropractic care.
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