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.
With group policies, it means that the insurance companies can do their actuarial work on the entire group in aggregate without having to have considerations about prorating based on certain individuals entering or leaving the policy throughout the year.
At least ostensibly. I doubt this actually happens. It’s mostly just a way to limit administrative overhead for both the insurance companies and the employers.
Don’t think for a moment that employers don’t like the whole open enrollment system too. Even if they CLAIM it is a PITA, it lets them only have to deal with this work for newly-qualified employees, separations, and otherwise only once a year.
Either way, it’s
of no benefitonly harmful to the actual consumers of the insurance. But since individuals aren’t the customers, that doesn’t matter.