Posted on 06/23/2025 6:39:39 PM PDT by Macho MAGA Man
In a press conference on Monday, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced a landmark agreement with the nation’s largest health insurers to tackle the number one healthcare problem plaguing hundreds of millions of Americans: prior authorization.
Prior authorization is the requirement for doctors and patients to get advance approval from insurance companies BEFORE certain treatments, tests, or procedures are covered. It was meant to control costs, but for 85% of Americans, it’s become a serious barrier to care.
“Doctors like myself are continually struggling with this issue,” Dr. Oz said, explaining how the bureaucratic process not only delays treatment but deeply frustrates both providers and patients.
In 2023 alone, Medicare Advantage (which covers about 32 million people) initially denied 3.2 million prior authorization requests. Dr. Oz made clear these are not just numbers: they represent “individuals who often, in the most vulnerable time in their lives, needed something done and it was denied.”
The burden also falls heavily on physicians. On average, doctors spend 12 hours per week on paperwork, handling about 40 prior authorization cases weekly. Dr. Oz said it contributes to burnout, slows down care, and “erodes public trust in the health care system.”
But under RFK Jr.’s leadership, things are changing for the better.
An HHS press release announced today that “health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers.”
These changes aim to ensure that patients and their doctors no longer have to battle insurance companies just to access common treatments like imaging, outpatient surgery, or physical therapy.
The cooperating insurers include UnitedHealthcare, Aetna, Blue Cross Blue Shield Association, Humana, Kaiser Permanente, The Cigna Group, Centene Corporation, Elevance Health, Highmark Health, CareFirst BlueCross BlueShield, and
(Excerpt) Read more at thegatewaypundit.com ...
They are why drug prices are so expensive.
I recently discovered insurance riders. With a rider, you can get a zero cost Medicare Advantage plan, and buy riders to cover hospitalization, prescription drugs, etc.
Haven’t looked too deep into riders yet, since I’m stuck with my current plan for the rest of the year.
Also, a person could have a job transition and not have their group insurance be affected. Legislation could allow the churches to receive reasonable revenues from the service that would go to strengthen the church.
You agree to pay for that immediately as well.
This is looking or specific coverage after you’ve paid for and agreed to your deal.
I hope this can make a difference.
One of the many problems with bureaucracy is that far too many people have to approve any authorization. This drags out approval timelines, and always results in most of those in the approval chain having little or no real knowledge about the specifics of any particular request. The organization I worked for before retiring was the pinnacle of bureaucratic. Approval processes would constantly expand and bloat in reaction to some one-off issue that arose somewhere. Instead of dealing with that particular case, they would just issue blanket edicts that bogged down the process for everyone.
Some examples: Our contracting process got so out of control that even after completing an RFP and selecting a vendor or consultant, it could take almost a year to get a contract approved. It made it almost impossible to do business, but no one seemed to care. Another: In a knee-jerk response to a small handful of travel expense issues, they changed our travel approval process to require every level up to and including the CFO to approve every travel request. It was idiotic. Above about one or two levels no one knew anything about the trip being requested, so had no personal knowledge to base any approval on, and the CFO certainly had no idea what she was approving. This change led to ridiculously long delays trying to get approvals, or even approval requests that would just never come back, requiring the requester to try to track down whose desk it was sitting on (and it was usually the CFO’s). Ironically, all this policy change did was actually INCREASE travel costs by introducing so much unpredictable delay that by the time approval was finally received the booking was last-minute, which dramatically increased the cost.
p
MA never makes sense. You give up way more than the crumbs you get.
Medicare plus Medicare Supplement Plan F Plan G or high deductible Plan F.
The other companies are :
“...and GuideWell, along with the industry trade group AHIP.”
Now get Medicare to cover the annual physical exam by the Dr that includes an EKG and standard blood work.
About eight months ago, I had scheduled a medical procedure for a Monday, I had to prepare for the procedure with five days of enoxaparin injections and to stop taking my blood thinners. Just as we were about to leave the house we got a call from the doctor’s office cancelling the procedure for lack of prior authorization. I had to complete the ten day series of enoxaparin injections. Ouch!
On the following Thursday I received a letter from the insurance company stating that the procedure was authorized. The letter was dated on the fore mentioned Monday. The procedure was rescheduled for a month later. I had to redo the enoxaparin injections which had a co-pay of $170.
I’m a pharmacy tech and a transplant recipient. I cannot tell you how many PA’s I deal with and how long it takes doctors AND insurance companies to respond. Patients get letters stating that their drugs are covered, but the company hasn’t updated their servers, and the drug is still denied for another week.
This is good news. Cost may go up, but at least people will get their meds.
Totally agree.
I appealed their denial of care for a rehab patient after stroke. Seven times I appealed their denial and won every appeal. I was medical POA on the case.
MileHi nails it!
I have, in fact, refused some tests once INS approved, based on ridiculous copays which amounted to over 50% of the stated cost of the test. That’s not insurance. That’s theft.
Plan G is excellent and you will need a drug plan, part D which vary..
Good luck!
Thanks. I will let them know.
I’m going through this right now.
Both my PCP AND an Orthopedic Surgeon have prescribed Physical Therapy for my knee.
The Insurance Company is giving me a hard time with “Prior Authorization”.
Thank you, RFKJr. for addressing this issue.
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