Insurers cut back on Medicare Advantage
Funding cuts to Medicare will affect Minnesota residents, with UnitedHealth exiting primarily in the southern part of the state. FOX 9’s Mike Manzoni has the latest details.
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Health insurance giant UnitedHealthcare announced on May 5 that it would eliminate prior authorization requirements for 30% of its medical services after complaints that its administration was delaying or denying people care.
The Minnesota-based insurer is one of several large insurance companies that has vowed to reduce its use of “prior authorizations,” which allow doctors and other health care providers to review applications before billing them for medical services or prescriptions. Doctors and patients have long criticized prior authorization, with surveys and government oversight reports saying the clinics routinely delay or deny treatment.
UnitedHealthcare announced it will eliminate prior authorizations for some outpatient surgeries, diagnostic tests such as echocardiograms, outpatient treatments, and chiropractic care by the end of 2026. Prior authorization is used for about 2% of medical services covered by UnitedHealthcare, and 92% of claims are approved within one day after they are submitted, the insurer said.
UnitedHealthcare CEO Tim Noel said in a statement that the move will make it easier for patients to receive care and give doctors more time with patients.
“We are working to further improve and refine our processes to make reviews faster, simpler and more efficient,” Noel said.
In June, insurers including United Healthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente and Humana joined Trump administration health officials in announcing they would reduce and streamline the use of prior authorizations. Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services Administrator Mehmet Oz said insurers were committed to making such changes on a voluntary basis.
But Oz said if insurers don’t make promised improvements, the federal government could introduce rules and regulations to force changes.
Insurers said the changes apply to 257 million Americans covered by private commercial insurance, Medicare Advantage and Medicaid managed care plans.
UnitedHealthcare announced in March that it would release data on prior authorizations and post the data on its corporate website.
Doctors complain that prior authorizations are onerous and often used to delay or deny medically necessary care to patients. In an American Medical Association survey of 1,000 physicians, 93% of physicians reported that prior authorization delayed patient care.
Insurers counter that authorization is an essential tool to prevent unnecessary tests and medical care that can increase medical costs for families. Consumers often must pay a portion of their medical costs through their insurance plan’s copayments, coinsurance, or deductibles. This is the amount you must pay before your insurance coverage begins.
