US Cuts Private Healthcare Approvals: Biden’s Money-Saving Strategy
TL/DR –
The Biden administration has introduced new regulations to speed up the healthcare approval process by private health insurance companies, requiring them to make decisions within 72 hours for urgent requests, provide reasons for denials, and publicly report denial metrics. However, the rules, which will come into effect in 2026, have been criticized for not adequately addressing the scale of the problem, which often results in care delays and difficult appeals processes. The new rules will cover companies working with Medicare, Medicaid and individual insurance exchanges, impacting approximately 105 million people, but will not apply to the 158 million Americans who rely on insurance from their employers or prior authorizations for medications.
Biden Administration Implements New Health Insurance Authorisation Rules
The Biden administration has introduced a new set of rules to streamline the process of obtaining prior authorization from private health insurance companies. This practice, which necessitates insurance company approval before a procedure or medication is provided, often results in care delays and a complex appeals process.
The newly established rules will necessitate insurance providers affiliated with federal programs to expedite the approval process and make decisions on urgent requests within 72 hours. Additionally, these providers will be required to publicly report denial metrics and provide specific reasoning for denied requests. The rules are set to come into effect predominantly in 2026.
Patients and advocates have expressed their approval of the new regulations, although they also noted their limitations. Aija Nemer-Aanerud, a healthcare campaign director for People’s Action Institute, praised the Biden administration for taking action on this issue, despite acknowledging that the rules may still allow insurance companies to profit from denying care.
The new regulations will apply to companies involved with Medicare, Medicaid, and individual insurance exchanges, impacting approximately 105 million people. However, the vast majority of privately insured Americans, namely the 158 million who rely on insurance from their employer, and prior authorizations for medications are not included in these regulations.
In a statement, America’s Health Insurance Plans, a trade organization, expressed support for the new rule.
Many patients, providers, and advocates argue that insurance companies often use the prior authorization process to delay and dissuade patients from receiving necessary care. Although the new rules are a positive step forward, there is still much work to be done to ensure that patients receive the care they need without excessive delays or complications.
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