Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
Well it’s obviously better because if consumers get mad about the decisions from the death panel at company A, they can just go to company B. Like if you don’t like McDonald’s, you can just go to Burger King instead.
Except there might not be a Burger King restaurant (let’s say in Burger King’s “network”) anywhere near where you live. And your employer already decided that everyone on the payroll has to eat at McDonald’s, and trying to deviate from that is a gigantic expensive hassle for some reason. And you’re basically locked into a single burger chain for the year, except for a tiny window of time when you can elect to switch. And you’re on the verge of starvation.