States Get in on the Prior Authorization Crackdown
Last month, my colleague Lauren Sausser told you about the Biden administration’s crackdown on insurance plans’ prior authorization policies, with new rules for certain health plans participating in federal programs such as Medicare Advantage or the Affordable Care Act marketplace. States are getting in on the action, too. Prior authorization, sometimes called pre-certification, requires patients […]
States Target Health Insurers’ ‘Prior Authorization’ Red Tape
Doctors, patients, and hospitals have railed for years about the prior authorization processes that health insurers use to decide whether they’ll pay for patients’ drugs or medical procedures. The Biden administration announced a crackdown in January, but some state lawmakers are looking to go further.
Biden Cracks Down on Prior Authorization — But There Are Limits
More than a year after it was initially proposed, the Biden administration announced a final rule yesterday that will change how insurers in federal programs such as Medicare Advantage use prior authorization — a long-standing system that prevents many patients from accessing doctor-recommended care. “When a doctor says a patient needs a procedure, it is […]
Will CMS Crack Down on Prior Authorization?
There’s the Idaho doctor whose infant daughter developed a brain tumor. A woman in Southern California who waited months for an MRI before dying in the hospital. And a North Carolina patient who has trigeminal neuralgia — a condition so painful it’s commonly called the “suicide disease.” They all have something in common, aside from […]
Older Americans Say They Feel Trapped in Medicare Advantage Plans
As enrollment in private Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.
Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions
Even people with good insurance aren’t guaranteed affordable care, as this KFF Health News follow-up to one patient’s saga shows.
Cancer Patients Face Frightening Delays in Treatment Approvals
Delaying cancer treatment can be deadly — which makes the roadblock-riddled process that health insurers use to approve or deny care particularly daunting for oncology patients.
Hospitals and Doctors Are Fed up With Medicare Advantage
Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF’s count. But among doctors and hospitals, it’s a different story. Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans […]
Doctors and Patients Try to Shame Insurers Online to Reverse Prior Authorization Denials
Prior authorization is a common tool used by health insurers for many tests, procedures, and prescriptions. Frustrated by the process, patients and doctors have turned to social media to publicly shame insurance companies and elevate their denials for further review.
Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients
The federal government wants to change the way health insurers use prior authorization — the requirement that patients get permission before undergoing treatment. Designed to prevent doctors from deploying expensive, ineffectual procedures, prior authorization has become a confusing maze that denies or delays care, burdens physicians with paperwork, and perpetuates racial disparities. New rules may not be enough to solve the problems.
