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.
Health Net does this BS all the time. Even care that has been previously approved and paid for is regularly denied if needed again because “It’s not a covered service.” It would literally take hours on the phone to convince Health Net’s customer service that they needed to pay a claim, and even then there was no guarantee that they would actually pay it. Three 60 minute calls to get a bill paid were not unusual.
One time Health Net refused to pay for care they had previously approved in writing. Monthly calls were ignored for 8 months until the medical center sent the bill to collections.
Increasing profits because your company refuses to pay for contracted & covered care should be illegal.