Health plans’ prior authorization processes are facing increased scrutiny. This summer, congressional committees began investigations of health plans’ automated review of requests for prior authorization for certain procedure codes. In response to this close examination of insurer practices, UnitedHealthcare (UHC), Cigna, and Blue Cross Blue Shield of Michigan announced that they would reduce the number of services that are subject to prior authorization. The codes that no longer require preapproval include a variety of medical services and equipment, including several orthopaedic procedures and devices.
In March 2023, ProPublica published a report alleging that Cigna relied on an automated system to reject prior authorization requests. During the same month, STATNews accused three Medicare Advantage plans — Humana, UHC, and CVS Health’s Aetna — of routinely relying on proprietary algorithms to deny coverage. Shortly thereafter, two congressional committees announced their investigations of the health plans’ prior authorization practices. On August 1, UHC began to eliminate prior authorization requirements, Cigna followed suit on August 24, and the Blues of Michigan did so on September 8, 2023.