New Biden Rules Aim to Curb 'Prior Authorization' By Private Health Ins Cos (Deny Care for 💵)
- ‘Make money by denying care’: new US rules aim to curb use of approval by private health insurances, The Guardian, Feb. 2, 2024. - Ed. Advocates welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem.
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek permission before obtaining medication or having a procedure. The cost-containment strategy often delays care and forces patients, or doctors, to navigate opaque and labyrinthine appeals.
The newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests.
The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The rules will primarily go into effect in 2026. Advocates welcomed the new rules but also noted their limitations and argued they do not go nearly far enough. "We’re glad the Biden administration is doing something about this issue,” said Aija Nemer-Aanerud with People’s Action Institute, an organization that advocates for people who have been denied care.
“The private insurance industry has figured out a lot of ways to set up the processes – regarding prior authorizations & claim denials – in such a way that they can make a profit,” said Nemer-Aanerud. But without going further, the rules will still allow insurance companies to, in Nemer-Aanerud’s words, “make money through denying people care”. The new rules will cover companies who work with Medicare, Medicaid and individual insurance exchanges – that means the rules will impact about 105M people.
That still leaves out the largest pool of privately insured Americans – the 158M who rely on insurance from their employer. The new rules also exclude prior authorizations for medications, though the federal government has said it intends to work on a rule for that in the future. Often, companies argue prior authorization saves patients’ money by reducing unnecessary care. Americans see doctors less often than people in other developed democracies and still spend more per person. Advocates argue companies often use the process to delay and discourage patients from getting care, even when it’s needed... - More, https://www.theguardian.com/us-news/2024/feb/02/new-federal-rule-insurance-authorization-surgery-medication
