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.
You might know this, just adding it as context.
Prior to Obamacare insurance companies would deny things like cancer when you switched insurances by calling it a ‘preexisting condition’. As in you had cancer before signing up for their insurance.
Companies loved this because it made their employees afraid to leave because their current insurance might cover their treatments, but switching jobs most likely mean that their new insurance wouldn’t.
The requirement to honor a “Certificate of Credible Coverage” with like a 30-day gap was a fucking godsend, and even then, health plans still didn’t have to cover any minimum set of services, medications, procedures, etc. like they do under the ACA. Insurance providers were free to just be like, “No, we don’t cover chemo at all, period, fuck off.” But more common, by far, was simply not covering prescriptions. Like, at all. You go to the doctor, get fixed up, and here’s to hoping the meds they want to give you are generic, because you’re paying out of pocket.