health insurance prior authorization

Prior Authorization Remains a Challenge

Getting timely prior authorization for needed medical care continues to pose a problem for patients and providers. Despite federal government action to address prior authorization concerns associated with health care programs it oversees – Medicare Advantage, Medicaid and CHIP fee-for-service and managed care plans, and Affordable Care Act Marketplace plans – and the insistence of some insurers that they have been addressing the issue, problems persist. According to a recent analysis by KFF (quoted directly): Medicare Advantage insurers denied 12% of standard prior authorization requests, Medicaid managed care insurers denied 14%, and ACA Marketplace insurers denied 18%. Denial rates for [...]

joe2026-08-27T16:21:27-04:00September 1, 2026|Affordable Care Act, Medicaid, Medicaid managed care, Medicare|

Federal Health Policy Update for May 7

The following is the latest health policy news from the federal government for May 1-7. Some of the language used below is taken directly from government documents. Congress Congress hopes to pass a reconciliation package to fund Immigration and Customs Enforcement (ICE) and Customs and Border Protection before June 1; lawmakers would then turn to a potential third reconciliation measure to address health care affordability before the mid-term elections. Health care provisions in a potential third reconciliation bill could include expanded access to health savings accounts (HSAs); changes to the rate at which the federal government matches state Medicaid spending [...]

joe2026-05-07T16:06:32-04:00May 7, 2026|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Insurer Use of Prior Authorization Down

The insurance industry appears to be making good on its pledge to reduce its use of prior authorization for services and to make that process simpler for providers and patients Last June, some of the leading health insurers agreed to work to address prior authorization challenges. Now, an AHIP-Blue Cross Blue Shield Association survey has found that they have reduced by 11 percent the number of procedures and services that require prior authorization, which translated into 6.5 million fewer requests. Medicare Advantage plans went even further, eliminating 15 percent of procedures and services that require prior authorization. In addition, the [...]

joe2026-04-08T13:38:49-04:00April 10, 2026|Uncategorized|