Nearly seven months after the fatal shooting of an insurance CEO in New York drew widespread attention to health insurers’ practice of denying or delaying doctor-ordered care, the largest U.S. insurers agreed Monday to streamline their often cumbersome preapproval system. Dozens of insurance companies, including Cigna, Aetna, Humana, and UnitedHealthcare, agreed to several measures, which include making fewer medical procedures subject to prior authorization and speeding up the review process. Insurers also pledged to use clear language when communicating with patients and promised that medical professionals would review coverage denials. While Trump administration officials applauded the insurance industry for its willingness to change, they acknowledged limitations of the agreement. “The pledge is not a mandate,” Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said during a news conference. “This is an opportunity for the industry to show itself.”
Dozens of insurance companies, including Cigna, Aetna, Humana, and UnitedHealthcare, agreed to several measures, which include making fewer medical procedures subject to prior authorization and speeding up the review process. Insurers also pledged to use clear language when communicating with patients and promised that medical professionals would review coverage denials.
While Trump administration officials applauded the insurance industry for its willingness to change, they acknowledged limitations of the agreement.
“The pledge is not a mandate,” Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said during a news conference. “This is an opportunity for the industry to show itself.”
6月23日，美国多家主要健保公司宣布将改革备受争议的“事先授权”（prior authorization）流程，以患者在接受治疗时因审批延误所面临的风险与焦虑。承诺的参与者包括UnitedHealthcare与Aetna等巨头。 “事先授权”指医生在为患者安排特定治疗、处方药或检查项目前，需获得保险公司的事前批准，否则相关费用可能不予报销。 尽管保险公司称此举旨在控制成本、防止资源滥用，但近年来，医生和患者普遍反映审批流程日益繁琐，导致治疗延迟甚至病情恶化。 今年3月，在参议院确认听证会上，特朗普提名的联邦医疗保险主任奥兹直言不讳地将该制度称为“系统性瘟疫”，批评其人为制造障碍、抬高行政成本。 面对愈演愈烈的政治与公众压力，保险公司周一联合宣布，将在未来一年半内采取以下改革措施：减少适用“事先授权”的医疗项目范围；在2026年前实现电子化流程标准化，简化申请与审批流程；允许患者在更换保险公司后的过渡期内，延续原保险公司已批准的授权；扩大自动、实时批准的服务类型和数量；确保被拒绝的请求必须经由专业医疗人员审查。 这些承诺将覆盖企业雇员保险、个人市场、联邦医疗保险优势计划（Medicare Advantage）以及联邦医疗补助计划（Medicaid）等多个群体。
我们普通人能做的只有捐款了吧。虽然他立志成为殉道者，但是他理应是这个时代的英雄史诗。
prior authorization条款现在是医保体系的毒瘤了
最可恶的是我从来不知道他们搞错了，也不知道那个authorization一直pending，甚至都不知道这检查还要anthorzie，直到检查前一天才收到一个女的留言，说因为没有批下来，所以把我的appointment取消了。可是我等了一个月啊。
然后我很愤怒地打电话去问才知道他们搞错了，然后轻飘飘的说可以帮我重新预约到一个月以后，我那个气得，这些人从医院到保险公司都是一坨翔！
我也碰到过类似的情况，非常离谱。
错误方不用担任何责任，只说帮你重新约个时间，然后重新等待。