UnitedHealthcare to cut prior authorization usage by 20%

UnitedHealthcare plans to cut back on its use of prior authorization, removing procedures and medical devices from its list of services requiring signoff and reducing the number of authorizations from 13 million to 10 million annually, according to a March 29 report from The Wall Street Journal.

Several procedures and devices will be removed starting in the third quarter. The insurer also plans to automate and speed up prior authorization over the next several years, according to the report. 

Next year, the insurer will also eliminate several prior authorization requirements for its "gold-card" physicians and hospitals, or those who nearly always get their requests approved. 

Other insurers, including the Cigna Group and CVS' Aetna, are removing prior authorization requirements and automating the process as well. 

While insurers claim that prior authorization tamps down costs and helps patients get the best care, physicians argue that the process is time-consuming and ineffective. 

According to a March study from the American Medical Association, prior authorization has delayed patient care for 94 percent of physicians. 

"We all know that requiring prior authorizations really only leads to more bureaucracy within the insurance company, as well as within each healthcare provider's practice, because now we need people to fill out these prior authorization forms, waste time trying to get through their 1-800 number to speak with someone who has no clinical knowledge, then be told we need to speak with someone else who actually does have some medical knowledge about why these procedures are necessary. This thereby leads to increased costs because we all need to hire more people to handle these needless requests," Linda Lee, MD, medical director of endoscopy at Boston-based Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, told Becker's. 

"We're not deaf to the complaints out there," Philip Kaufman, chief growth officer at UnitedHealthcare, told The Wall Street Journal. "We've taken a hard look at ourselves and this process." 

Last year, the Department of Health and Human Services reported that 13 percent of prior-authorization denials by Medicare Advantage plans were for benefits that should have been covered, according to the report. 

United has yet to specify what services will be affected by the change but suggested they will include certain types of medical equipment and genetic testing used for diagnosis. 

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