In a significant move to address one of the most criticized aspects of U.S. health care, the nation's leading health insurers — including UnitedHealthcare and CVS Health's Aetna — announced Monday that they will scale back and streamline the widely disliked practice of prior authorization, which has long been blamed for delays and complications in patient care.
The companies plan to reduce the number of health care claims that require prior authorization, standardize electronic processes, and expand real-time decision-making for requests. They also committed to honoring approvals issued by previous insurers for a period after patients switch health plans.
Why It Matters
Prior authorization requires health care providers to obtain insurer approval before covering a service, such as an imaging exam or a prescription. Insurers argue the practice helps prevent overuse and ensures appropriate treatment. But many doctors say the process has become overcomplicated and overly expansive, frequently delaying necessary care.
What To Know
Dr. Mehmet Oz, during his March Senate confirmation hearing for the role of CMS administrator, condemned the practice as "a pox on the system" that increases administrative costs.
Dr. Ashley Sumrall, an oncologist in Charlotte, North Carolina, said she has witnessed a rise in prior authorization requirements for routine but vital exams like MRIs.
"There's a term that we use called 'scanxiety,' and it's very real," said Sumrall, who treats brain tumors. She emphasized the emotional and clinical toll of delays in imaging, which are crucial for assessing whether a treatment is effective.
Sumrall also criticized the inconsistent and opaque nature of the process, noting that every insurer " has their own way of doing business.
However, she welcomed the industry's new commitments. "For years, the companies have been unwilling to compromise, so I think any step in the direction of standardization is encouraging," she said.
The proposed changes come in the wake of rising public frustration, intensified after the December shooting death of UnitedHealthcare CEO Brian Thompson, which prompted widespread airing of grievances over insurance practices like prior authorization.
The reforms, which insurers say will take effect in stages through 2026 and 2027, aim to reduce administrative barriers and improve access to timely care. According to the insurers, the measures will apply across employer-sponsored and individual plans, as well as Medicare Advantage and Medicaid coverage.
Researchers note that prior authorization has grown more prevalent as health care costs rise, particularly in areas like lab testing, physical therapy, prescription drugs, and imaging.
"We're sort of trapped between care being unaffordable and then these nonfinancial barriers and administrative burdens growing worse," said Michael Anne Kyle, an assistant professor at the University of Pennsylvania who studies health care access.
A recent analysis by the Kaiser Family Foundation (KFF) found that nearly all Medicare Advantage enrollees are subject to prior authorization for certain services, especially high-cost treatments such as hospital stays. In 2023, insurers denied roughly 6 percent of all prior authorization requests, according to the study.
To address such issues, insurers also promised to ensure that medical professionals—not administrative staff—review denied requests moving forward.
What People Are Saying
Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, Maryland, told Newsweek: "Business decisions are typically strategic rather than accidental."
Tom Baker, a professor of law at the University of Pennsylvania Carey Law School, told Newsweek: "If these measures are effective, Americans should have to wait less time to receive necessary procedures, and health care providers should have more time to spend with patients.
Baker added that while American health care "needs streamlining," it is also important to remember that "we have given private health insurers an impossible job."
"We ask them to facilitate low friction access to needed care while also controlling health care costs," he added.
What Happens Next
With mounting pressure from patients, providers, and policymakers, the insurers' new commitments mark a potentially transformative step toward simplifying a system that has long frustrated the very people it's intended to serve.
This article includes reporting by The Associated Press.
Update: 6/23/25, 4:39 p.m. ET: This article was updated with new information and remarks.
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