Robert Kennedy, Mehmet Oz Announce and Insurance Providers Co-Sign Pre-Authorization Process Changes
Share this @internewscast.com

On Monday, Health and Human Services (HHS) Secretary Robert Kennedy, along with Dr. Mehmet Oz, the Administrator for Centers for Medicare & Medicaid Services (CMS), held a press conference committing to streamline the authorization processes for Medicare, Medicaid, the Health Insurance Marketplace, and commercial plans that serve the majority of Americans.

The HHS website press release announced,

Basically, every major health insurer in the United States. This matters. 

“I want to thank the insurance companies for making these commitments today. Americans should not have to bargain with their insurer to receive the care they require,” said Secretary Kennedy. “Putting patients and their doctors in opposition to large corporations wasn’t beneficial for anyone. We are actively collaborating with the industry to simplify obtaining prior authorization for routine services such as diagnostic imaging, physical therapy, and outpatient surgery.”

For those fortunate enough to have never experienced the hassle of needing a pre-authorization or a physician referral for a screening or further diagnosis, you are indeed lucky. A relative was hospitalized with a serious, though not catastrophic, condition. He was discharged after seven days due to that being the maximum duration his insurance provider would cover. Since he needed to consult his primary care physician before seeing a specialist, he endured an additional week post-hospitalization. He eventually met with his PCP and secured a specialist referral, but with approvals, it took another two weeks before he was able to see that specialist. Multiply that by several conditions, numerous practitioners, and even longer wait times, and you magnify the stress and worsen health conditions because of this convoluted insurance process.

“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” said Administrator Oz. “We applaud these voluntary actions by the private sector, which is how these types of issues should be solved. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”

And this is only one aspect of how the insurance authorization system has made patients’ lives miserable. With the new changes outlined, the major insurers have committed to:

  • Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces.
  • Reduce the volume of medical services subject to prior authorization by January 1, 2026.
  • Honor existing authorizations during insurance transitions to ensure continuity of care.
  • Enhance transparency and communication around authorization decisions and appeals.
  • Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
  • Ensure medical professionals review all clinical denials.

Despite making noises in the past to reform the system, the major providers appear more invested in the overhaul process this time around. One reason could well be that it has become a matter of life and death for them. The December 2024 murder of UnitedHealthcare CEO Brian Thompson in New York was purportedly because the alleged killer, Luigi Mangione, was denied a procedure that would have improved his quality of life. With 40 percent of Gen Z supporting Mangione, saying that his actions were justified under the circumstances, the insurance provider CEOs are making very public moves to ensure Americans see their commitment to change, and that they will do what is within their power to see it done.

Share this @internewscast.com
You May Also Like
America's 'most hated mom,' Casey Anthony, spotted on apparent date at sports bar

Casey Anthony Seen on Outing at Local Sports Bar: Reports

New images show “America’s most hated mom,” Casey Anthony, out on what…
NWS faces vacancies in Florida offices as 2025 hurricane season ramps up

NWS Struggles with Florida Office Vacancies as 2025 Hurricane Season Intensifies

Tom Fahy, the Legislative Director for the National Weather Service Employees Organization,…
Karen Read asks Massachusetts court to throw out wrongful death lawsuit after murder acquittal

Karen Read Requests Massachusetts Court to Dismiss Wrongful Death Lawsuit Following Her Murder Acquittal

Karen Read, who was exonerated from murder charges last month concerning the…
Jacksonville dance instructor arrested for sex crime with minor

Jacksonville Dance Teacher Charged with Sexual Offense Involving Minor

Samuel Penalba, 34, is also accused of trying to delete photo and…
Photo of a teenage girl and a woman.

Brave 17-year-old dies rescuing his entire family from a van that fell off a cliff into dangerous floodwaters.

A BRAVE teenager saved her entire family after their van plunged off…
Police investigating death of Maine paddleboarder as a homicide after discovery of body

Maine Paddleboarder’s Death Now Being Investigated as a Homicide After Body is Found

UNION, Maine — Police in Maine are investigating the death of a…
Ovidio Guzmán López, son of Joaquin 'El Chapo' Guzman, expected to plead guilty in Chicago court Friday

Ovidio Guzmán López, the son of drug kingpin ‘El Chapo’, anticipated to enter a guilty plea in Chicago court this Friday

CHICAGO (WLS) — The son of convicted Mexican drug lord Joaquin “El…
Federal audit of Rebuild Florida Program underway

Federal Review Begins for Rebuild Florida Initiative

The Deputy Inspector General for HUD discusses an audit of the Rebuild…
'General Hospital,' 'The View,' 'Live with Kelly and Mark,' and Anthony Mackie are among the Daytime Emmy Awards nominees.

Daytime Emmy Nominations Include ‘General Hospital,’ ‘The View,’ ‘Live with Kelly and Mark,’ and Anthony Mackie

LOS ANGELES — The National Academy of Television Arts & Sciences has…
Angela Paxton at her husband's impeachment trial.

Senator Angela Paxton Announces Divorce from Texas Attorney General Ken on Biblical Grounds After Nearly 40 Years of Marriage

TEXAS Senator Angela Paxton has filed for divorce from her attorney general…
Moderna Vaccine Dangers: What You Should Know

Understanding the Risks Associated with the Moderna Vaccine

The U.S. Food and Drug Administration granted full approval to Moderna’s COVID-19…
LSU lands No. 1 college football recruit Lamar Brown in huge get

LSU Secures Top College Football Prospect Lamar Brown in Major Win

The No. 1 recruit in the 2026 recruiting class, according to ESPN’s…