Health Insurers Aim to Simplify Pre-Authorization Process

Major US health insurance companies, including UnitedHealthCare and Kaiser Permanente, are working to make healthcare more accessible and efficient for patients.

The American Health Insurance Plans (AHIP), which represents the industry’s interests, announced on Monday that several prominent members are initiating efforts to simplify the “pre-authorization” process. This is essentially the procedure healthcare providers must follow to get approval from insurers before delivering care.

Physicians often find that obtaining these approvals takes considerable time, which can lead to frustration due to delays in getting patients the necessary care. An investigation by the American Medical Association revealed that medical offices typically spend about 12 hours weekly on these approval requests, time that could be spent on patient care.

Under a new agreement, participating insurance companies have committed to speeding up this cumbersome process. They will implement a standardized online submission system for pre-authorization, reduce the number of services requiring approval, and enhance the speed of real-time responses. These changes are expected to roll out between 2026 and 2027.

Mike Tuffin, the CEO of AHIP, stated that the current healthcare system is fragmented and bogged down by outdated manual processes, negatively impacting both patients and providers. He emphasized that health plans are committed to improving patient experiences, which should allow healthcare providers to focus more on care delivery.

Sean Martin, CEO of the US Academy of Family Physicians, acknowledged that while this initiative is a positive step, its actual implementation will determine its effectiveness for both patients and physicians.

A number of insurers have expressed their commitment to these reforms, including various Blue Cross and Blue Shield plans, as well as Medicare and Medicaid providers. AHIP estimates that these combined efforts could positively affect over 250 million Americans.

• Amerihealth Caritas
• Arkansas Blue Cross and Blue Shield
• Idaho Blue Cross
• Alabama Blue Cross Blue Shield
• Arizona Blue Cross Blue Shield
• Hawaiian Blue Cross and Blue Shield
• Kansas Blue Cross and Blue Shield
• Kansas City Blue Cross and Blue Shield
• Louisiana Blue Cross and Blue Shield
• Massachusetts Blue Cross Blue Shield
• Michigan Blue Cross Blue Shield
• Minnesota Blue Cross and Blue Shield
• Nebraska Blue Cross and Blue Shield
• North Carolina Blue Cross and Blue Shield
• North Dakota Blue Cross Blue Shield
• Rhode Island’s Blue Cross and Blue Shield
• South Carolina Blue Cross Blue Shield
• Tennessee Blue Cross Blue Shield
• Wyoming Blue Cross Blue Shield
• California Blue Shield
• Capital Blue Cross
• Capital District Physicians’ Health Plan, Inc. (CDPHP)
• CareFirst Blue Cross Blue Shield
• Saintney
• Cigna Group
• CVS Health Aetna
• eLlevance Health
• Excellus Blue Cross Blue Shield
• Geisinger Health Plan
• Guidewell Mutual Holding Corporation
• Healthcare Services Corporation
• HealthFirst (New York)
• Highmark Inc.
• Horizon Blue Cross Blue Shield in New Jersey
• Humana
• Independent Blue Cross
• Independent Health
• Kaiser Permanente
• LA Care Health Plan
• Molina Healthcare
• Rhode Island Neighborhood Health Plan
• Point32Health
• Premera Blue Cross
• Regence BlueShield, including its divisions in Idaho and Oregon
• Scan Health Plan
• Summit Health
• UnitedHealthCare
• Wellmark Blue Cross and Blue Shield