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About three-quarters of the country’s health insurance providers signed a series of commitments this week to improve patient care by reducing the bureaucratic hurdles caused by insurance companies’ pre-approval requirements.
Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services, together with Robert F. Kennedy Jr., secretary of health and human services, announced a new voluntary pledge from senior insurance provider executives that cover about 75% of the population at a press conference on Monday. The new commitment aims to speed up and reduce the pre-approval process used by insurers, a process that has long been sorted out because patient care and other bureaucratic hurdles are unnecessarily delayed to negatively affect patients.
“The pledge is not a mission. It’s not a bill, it’s not a rule. It’s not a legislation. It’s an opportunity for the industry to show itself,” Oz said Monday. “But it’s a good start and the response is overwhelming with the fact that three-quarters of the domestic patients are already covered by participants in this pledge.”
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The health insurance company, representing approximately 75% of U.S. patients, signed an industry-led pledge this week aimed at improving patient care by streamlining the long-term pre-approval process used by insurers to ensure patients are receiving proper care. (Getty Images; ap; istock)
Pre-approval is the process in which the provider requires that the provider obtain approval from the patient’s insurance provider before it can provide a specific treatment or service. Essentially, this process is trying to ensure that patients get the right solution for a particular problem.
However, according to OZ, the process forces physicians to spend a huge amount of human resources to meet pre-approval requirements from insurance companies. He said, on average, doctors must spend 12 hours a week to address these requirements, but they see around 40 people a week.
“It irritates doctors. It sometimes brings about significantly delayed care. It erodes public trust in the healthcare system. It’s something we can’t accept,” Oz argued.
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Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services, said at a press conference Monday that announced the new industry-led pledge, that the new commitments will significantly improve patient access to care. (Anna Money Maker/Getty Images)
This pledge is adopted by some of the largest insurance providers in the United States, including United Healthcare, Cigna, Humana, Blue Cross & Blue Shield, and Aetna. Industry-led commitments aim to improve patient care, but if patients start seeking care more frequently, they may also eat profits.
Commitments from insurance companies that were solidified this week include taking proactive steps to implement a common standardized process for electronic pre-approval through the development of standardized submission requirements to support faster turnaround times. The goal is to operate the new framework by January 1, 2027.
Another part of the pledge includes commitments from individual insurance plans to implement certain reductions in the use of medical pre-approval by January 1, 2026. If a patient switches insurance provider during treatment on that day, they must respect the existing pre-approval approval for 90 days during patient transition.
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Advance approval is a lengthy critical process in which critics claimed to block access to patient care. (istock)
Transparency is also an important part of the new commitment from insurance providers. The health plan ordered by the Commitment pledges to provide a clear and easy-to-understand explanation of the advance approval decision, including guidance on appeal. The commitment also states that by 2027, 80% of electronic pre-approval approvals from businesses will be responded in real time.
At a press conference on Monday, Oz compared the industry-led pledge to the Bible, saying “Meekness inherits the earth.”
“I grew up thinking that ‘meek’ meant weakness, but that doesn’t mean meek. “Meek” means you have a sword that can do real damage to the people around you, but you decide to cover that sword and clean it up for a while, and you can still compete even if we are together for a while.
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“That’s what these insurers and hospital systems did,” he continued. “They agreed to cover their swords to be meek for a while and come up with a better solution to the problems that bother us all.”
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