June 23, 2025
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Health insurers, including Independence Blue Cross, Aetna and UnitedHealthCare, are committing to make it easier for patients to gain prior authorizations, and to reduce the need for them.
Major health insurance providers have agreed to reduce the need for prior authorization — the requirement that patients must get approval from insurers before receiving certain treatments or risk paying out of pocket.
The insurers also have committed to streamlining and simplifying a process that has caused frustration for patients and caregivers alike. The changes will benefit 257 million Americans, including those with commercial, Medicare Advantage and Medicaid managed care plans, according to AHIP, the trade group that announced the agreement.
The participating insurers include Independence Blue Cross, Geisinger Health Plan, Aetna and UnitedHealthcare. They have agreed to standardize data and submission requirements for digital prior authorization by Jan. 1, 2027, a move AHIP says means faster access to treatment for patients and more efficiency among health care companies.
By next year, the insurers also plan to reduce the type of care that require prior authorization and honor existing prior authorizations for 90 days when patients change insurers during their treatment. They also will give clear explanations of prior authorization determinations, including support for appeals. And by 2027, at least 80% of prior authorizations will be approved in real time with clinical documentation.
"The American health care system must work better for people, and we will improve it in distinctive ways that truly matter,” Aetna President Steve Nelson said in a statement. "We support the industry's commitments to streamline, simplify and reduce prior authorization."
Independence Blue Cross said this commitment expands on a joint program it began with Penn Medicine two years ago to cut down the time spent on prior authorizations for outpatient scans, including CTs, MRIs and echocardiograms. Providers who have met certain criteria for at least 12 months receive automatic prior authorization for certain imaging.
According to IBX, 83% of outpatient radiology requests are approved in one-tenth the time it typically takes for prior authorization. There has been a 9% decrease in requests for tests that are unlikely to provide useful information for diagnosis or treatment.
"These efforts will help our members get the treatments and medical services they need more quickly and easily," IBX Vice President and COO Richard Snyder said in a statement. "They will also ease the administrative burdens on our network providers."
