Latest news with #priorauthorization
Yahoo
3 days ago
- Business
- Yahoo
Multi-millionaire Trump official Dr. Oz appears not to know how credit cards work
Centers for Medicare and Medicaid Administrator Dr. Mehmet Oz appeared to let slip that he doesn't quite grasp how credit cards work. The former revered heart surgeon-turned-television host appeared on Fox News' Ingraham Angle to discuss America's largest health insurance companies pledging to streamline prior authorization. After giving a confusing analogy that compared approving procedures to credit card transactions, Oz made an unintentional admission: he doesn't know how one works. 'We've insisted on a dashboard. They have to be public about what they're doing,' he told Laura Ingraham on Wednesday. 'We want to know, for example, by the end of this year, can you do these examinations instantaneously?' 'Like a credit card,' Oz, who boasts an estimated $200 million net worth, continued. 'When you put it into the machine to buy something, they don't prior authorize you. You either have money in the bank or you don't.' Credit card companies do prior authorization on every transaction to determine whether money can be spent, which includes checking if the card is valid, that there's enough credit available, and if there are any signs of fraud. Individuals also borrow and spend money on their payment cards that they do not physically have in the bank. Oz was seemingly trying to illustrate that medical approvals should be quick and automated, like credit card checks. UnitedHealthcare, Aetna, Cigna, and Humana were among dozens of medical insurance companies that agreed to several measures on Monday, including making fewer medical procedures subject to prior authorization. If the companies follow through, patients would have to jump through fewer bureaucratic hoops, receive faster treatment approvals, and have enhanced continuity of care. Speaking to reporters Monday, Oz said that the pledge is 'not a mandate,' adding: 'This is an opportunity for the industry to show itself.' The CMS head also said he wants insurers to eliminate preapprovals for knee arthroscopy, a common, uncomplicated procedure to diagnose and treat knee issues. On Wednesday, Oz explained that he and Health and Human Services Secretary Robert F. Kennedy Jr. went to the insurance industry directly to tell them their old model was 'inefficient.' ''Secretary Kennedy feels this is wrong, the president feels this is wrong, we have to make a deal,'' he told Ingraham of his apparent dressing down of executives. ''So either you do it or we're gonna do it for you, and it's a lot less painful if you guys get together and figure this out and actually make a pledge.''
The Independent
3 days ago
- Business
- The Independent
Multi-millionaire Trump official Dr. Oz appears not to know how credit cards work
Centers for Medicare and Medicaid Administrator Dr. Mehmet Oz appeared to let slip that he doesn't quite grasp how credit cards work. The former revered heart surgeon-turned-television host appeared on Fox News' Ingraham Angle to discuss America's largest health insurance companies pledging to streamline prior authorization. After giving a confusing analogy that compared approving procedures to credit card transactions, Oz made an unintentional admission: he doesn't know how one works. 'We've insisted on a dashboard. They have to be public about what they're doing,' he told Laura Ingraham on Wednesday. 'We want to know, for example, by the end of this year, can you do these examinations instantaneously?' 'Like a credit card,' Oz, who boasts an estimated $200 million net worth, continued. 'When you put it into the machine to buy something, they don't prior authorize you. You either have money in the bank or you don't.' Credit card companies do prior authorization on every transaction to determine whether money can be spent, which includes checking if the card is valid, that there's enough credit available, and if there are any signs of fraud. Individuals also borrow and spend money on their payment cards that they do not physically have in the bank. Oz was seemingly trying to illustrate that medical approvals should be quick and automated, like credit card checks. UnitedHealthcare, Aetna, Cigna, and Humana were among dozens of medical insurance companies that agreed to several measures on Monday, including making fewer medical procedures subject to prior authorization. If the companies follow through, patients would have to jump through fewer bureaucratic hoops, receive faster treatment approvals, and have enhanced continuity of care. Speaking to reporters Monday, Oz said that the pledge is 'not a mandate,' adding: 'This is an opportunity for the industry to show itself.' The CMS head also said he wants insurers to eliminate preapprovals for knee arthroscopy, a common, uncomplicated procedure to diagnose and treat knee issues. On Wednesday, Oz explained that he and Health and Human Services Secretary Robert F. Kennedy Jr. went to the insurance industry directly to tell them their old model was 'inefficient.' ''Secretary Kennedy feels this is wrong, the president feels this is wrong, we have to make a deal,'' he told Ingraham of his apparent dressing down of executives. ''So either you do it or we're gonna do it for you, and it's a lot less painful if you guys get together and figure this out and actually make a pledge.''
Fox News
6 days ago
- Health
- Fox News
Trump admin secures pledge from 75% of health insurers in bid to improve patient care
Roughly three-quarters of the nation's health insurance providers signed a series of commitments this week in an effort to improve patient care by reducing bureaucratic hurdles caused by insurance companies' prior-authorization requirements. Director of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, alongside Health and Human Services Secretary, Robert F. Kennedy Jr., announced the new voluntary pledge from a cadre of insurance providers, who cover roughly 75% of the population, during a press conference Monday. The new commitments are aimed at speeding up and reducing prior-authorization processes used by insurers, a process that has been long-maligned for unnecessarily delaying patient care and other bureaucratic hurdles negatively impacting patients. "The pledge is not a mandate. It's not a bill, a rule. This is not legislated. This is a opportunity for industry to show itself," Oz said Monday. "But by the fact that three-quarters of the patients in the country are already covered by participants in this pledge, it's a good start and the response has been overwhelming." Prior-authorization is a process that requires providers to obtain approval from a patient's insurance provider before that provider can offer certain treatments or services. Essentially, the process seeks to ensure patients are getting the right solution for a particular problem. However, according to Oz, the process has led to doctors being forced to spend enormous amounts of man-power to satisfy prior-authorization requirements from insurers. He noted during Monday's press conference that, on average, physicians have to spend 12 hours a week dealing with these requirements, which they see about 40 of per week. "It frustrates doctors. It sometimes results in care that is significantly delayed. It erodes public trust in the healthcare system. It's something we can't tolerate," Oz insisted. The pledge has been adopted by some of the nation's largest insurance providers, including United Healthcare, Cigna, Humana, Blue Cross & Blue Shield, Aetna and many more. While the industry-led commitments aim to improve care for patients, it could potentially eat into their profits as well if patients start seeking care more often. The commitments from insurers cemented this week include taking active steps to implement a common standardized process for electronic prior-authorization through the development of standardized submission requirements to support faster turnaround time. The goal is for the new framework to be operational by Jan. 1, 2027. Another part of the pledge includes a commitment from individual insurance plans to implement certain reductions in its use of medical prior-authorization by Jan. 1, 2026. On that date, if patients switch insurance providers during the course of treatment, their new plan must honor their existing prior-authorization approvals for 90-days while the patient transitions. Transparency is also a key part of the new commitments from insurance providers. Health plans enjoined with the commitments will pledge to provide clear and easy-to-understand explanations of prior-authorization determinations, including guidance for appeals. The commitment also states that by 2027, 80% of electronic prior-authorization approvals from companies will be answered in real-time. Oz, during the Monday press conference, compared the industry-led pledge to the Bible, saying, "The meek shall inherit the earth." "I always grew up thinking 'meek' meant weak, but that's not what meek means. 'Meek' means you have a sharp sword, a sword that could do real damage to people around you, but you decide, electively, to sheathe that sword and put it away for a while, so you can do goods, so you can do important things where once in a while we have to get together, even if we're competitors, and agree," Oz said Monday. "That's what these insurance companies and hospital systems have done," he continued. "They have agreed to sheathe their swords to be meek for a while, to come up with a better solution to a problem that plagues us all."
CBS News
6 days ago
- Health
- CBS News
Health insurers move to streamline prior authorization process, promising quicker care
UnitedHealthcare , Kaiser Permanente and other major U.S. health insurers say they want to make it faster and easier for patients to obtain care. Health Insurance Plans (AHIP), a trade association that represents the health insurance industry, announced Monday that some of its biggest members are taking steps to streamline "prior authorization" — industry jargon for the process by which health care providers obtain approval from patients' insurance carriers to deliver care. Prior authorization requests can be time-consuming for doctors, resulting in frustrating delays for patients in obtaining essential medical care. According to a survey from the American Medical Medical Association, physicians' offices spend an average of 12 hours per week seeking approval for services from insurers, administrative hurdles that critics say takes time away from providing care. As part of the new agreement, participating insurers have committed to a series of steps they say will speed up the sluggish process. That includes creating a standardized system for submitting prior authorization online, reducing the amount of claims subject to prior authorization and ramping up real-time responses to requests. Such changes are scheduled to take effect in 2026 and 2027. "The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike," AHIP CEO Mike Tuffin said in a statement. "Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system." Shawn Martin, CEO of the American Academy of Family Physicians, said in a statement that the insurance industry initiative is a "step in the right direction," but that the real test will be the impact it has on the experiences of patients and physicians. Dozens of insurers signed onto the commitment, including a number of state Blue Cross and Blue Shield plans and some Medicare and Medicaid plans. In all, AHIP says the joint effort to improve prior authorization could benefit more than 250 million Americans. The signatories include: AmeriHealth Caritas Arkansas Blue Cross and Blue Shield Blue Cross of Idaho Blue Cross Blue Shield of Alabama Blue Cross Blue Shield of Arizona Blue Cross and Blue Shield of Hawaii Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas City Blue Cross and Blue Shield of Louisiana Blue Cross Blue Shield of Massachusetts Blue Cross Blue Shield of Michigan Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Nebraska Blue Cross and Blue Shield of North Carolina Blue Cross Blue Shield of North Dakota Blue Cross & Blue Shield of Rhode Island Blue Cross Blue Shield of South Carolina BlueCross BlueShield of Tennessee Blue Cross Blue Shield of Wyoming Blue Shield of California Capital Blue Cross Capital District Physicians' Health Plan, Inc. (CDPHP) CareFirst BlueCross BlueShield Centene The Cigna Group CVS Health Aetna Elevance Health Excellus Blue Cross Blue Shield Geisinger Health Plan GuideWell Mutual Holding Corporation Health Care Service Corporation Healthfirst (New York) Highmark Inc. Horizon Blue Cross Blue Shield of New Jersey Humana Independence Blue Cross Independent Health Kaiser Permanente L.A. Care Health Plan Molina Healthcare Neighborhood Health Plan of Rhode Island Point32Health Premera Blue Cross Regence BlueShield, Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Asuris Northwest Health, BridgeSpan Health SCAN Health Plan SummaCare UnitedHealthcare Wellmark Blue Cross and Blue Shield
Reuters
7 days ago
- Health
- Reuters
Health insurers to work on easing prior authorization requirements, AHIP says
June 23 (Reuters) - America's Health Insurance Plans said on Monday that U.S. health insurers will take additional measures to simplify their requirements for prior approval on medicines and medical services. Health insurers will work to develop standardized data and submission requirements for electronic prior authorization by January 1, 2027, the industry trade group said in a statement. The firms will also work on reducing the scope of claims that require prior authorization by January 1, 2026, and ensure the authorizations are valid for a 90-day period if the patient changes insurance companies during the course of treatment. U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid Services Administrator Mehmet Oz are scheduled to discuss health insurance reforms in a press conference later in the day. "The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike," AHIP CEO Mike Tuffin said. Separately, CVS Health's (CVS.N), opens new tab insurance unit Aetna announced a series of measures on Monday. This included the move to bundle multiple authorization requests into one upfront approval for people with lung, breast or prostate cancer who need such authorizations for MRI or CT scans. The killing of the head of UnitedHealth's (UNH.N), opens new tab insurance unit last year had ignited significant social media backlash from Americans struggling to receive and pay for medical care. UnitedHealth had said in March it would ease requirements to get insurance authorization when renewing prescriptions on about 80 drugs, aiming to eliminate up to 25% of reauthorization requirements.
