() HHS Secretary Robert F. Kennedy Jr. said he is “cautiously confident” that health insurers in the U.S. will follow the new guidelines put in place on the prior authorization process.
“If they don’t comply, we still have a gorilla in the closet, which is legislation and we have a lot of different hammers we could bring down on them,” Kennedy said during an appearance on ‘s “CUOMO.” “They have agreed to do this in the past and they did nothing, but this time is different.”
Kennedy added there are also regulatory sanctions currently before Congress to make sure health insurers stay in compliance.
“It’s trust-verified, and I think this is closer than we’ve ever gotten, and the agreements are very, very solid,” Kennedy said.
The nation’s top health insurers have pledged to streamline their process for prior authorization, which has been a frustration for many Americans by delaying care and creating complications. Prior authorization means the insurers require approval before they cover medical care, a prescription or a service such as an imaging exam. They say the process is done to guard against care overuse and make sure patients get the right treatment.
“Patients should not be waiting because bureaucratic hurdles are blocking their medical treatment,” Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said at a news conference unveiling the pledge Monday afternoon.
According to HHS, the health insurers have pledged to make six key reforms, which include standardizing the electronic prior authorization process, reducing the number of services subject to prior authorization and enhancing transparency around authorization decisions.
By 2027, health insurers will expand real-time responses so there will be real-time approvals for most requests.
