Health insurers pledge to streamline ‘prior authorization’ process

Dr. Oz discusses Medicare and Medicaid

Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz says that "special interests are pushing misleading talking points to try and stop the most ambitious healthcare reforms ever. Oz’s sentiment comes as Senate Majority Leader John Thune, R-S.D., and Senate Republicans sprint to finish their work on President Donald Trump’s "big, beautiful bill" ahead of a self-imposed July 4 deadline.

Some of the nation’s major health insurers pledged they would streamline the prior-authorization process, a practice that often leads to delays and complications for many patients in the United States.

"This is a critical issue because, imagine you're in a doctor's office and you've got a bad diagnosis, and there's a procedure or test or treatment that you think is right for you, and you find out that you can't start that treatment for sometimes weeks, maybe longer. It's more frustrating than anything else in the process, because at least that's something you do control. You don't control much else when you're in a physician's office with that kind of a crisis. And yet it's withheld, and these approvals with this new pledge will be streamlined. It will happen very quickly," Dr. Mehmet Oz said during a Monday news conference.

UnitedHealthcare, CVS Health's Aetna and dozens of other insurers said they plan to reduce the type of health care claims that require prior authorization, according to federal health officials. 

What is prior authorization?

Big picture view:

Prior authorization means insurers require approval before they’ll cover medical care, a prescription or a service like an imaging exam.

Researchers say prior authorization has grown more common as care costs have climbed, especially for prescription drugs, lab testing, physical therapy and imaging exams.

Dig deeper:

Insurers say they do this to guard against care overuse and to make sure patients get the right treatment.

The other side:

But doctors say the practice has grown in scope and complication, leading to frequent care delays.

The fatal shooting of UnitedHealthcare CEO Brian Thompson in December prompted many people to vent their frustrations with coverage issues like prior authorization.

What's changing:

Insurers said Monday that they will standardize electronic prior authorization by the end of next year to help speed up the process. They will reduce the scope of claims that require prior authorization, and they will honor the preapprovals of a previous insurer for a window of time after someone switches plans.

They also plan to expand the number of real-time responses and ensure medical reviews are done for denied requests.

Why you should care:

Doctors say delays from requests that are eventually approved or coverage rejections can harm patients by giving a disease time to progress untreated. They also can spike anxiety in patients waiting to hear back on coverage.

US Department of Health and Human Services

Big picture view:

Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz held a press conference Monday to announce the changes. 

Screen grab of Dr. Mehmet Oz speaking at a news conference on June 23, 2025, to discuss a pledge by some major health providers to streamline the pre-authorization process. (LiveNOW from FOX)

What they're saying:

On Monday, Oz went into detail as to why the federal government is stepping in to help overhaul the pre-authorization process for U.S. patients, saying "it's inefficient." 

"We want less red tape. And if we do that, we can cut tens of billions of dollars of administrative waste. It's a lot of money that we throw at solutions that don't work for us because we have a digital infrastructure that's being addressed. With less red tape that means more resources for patients," Oz continued. 

Actor Eric Dane, known for his roles in "Grey's Anatomy" and "Euphoria," joined the news conference to share his approval of the pledge being offered by some health providers. 

"Anything we can do to give patients more certainty with fewer delays is a worthwhile endeavor," Dane said. 

Dane was diagnosed with ALC, also known as Lou Gehrig's disease, earlier this year and Dane has recently begun to share his health journey publicly for the first time.