Cigna will eliminate prior authorization requirements for more than 600 procedures in its commercial plans as pressure mounts on insurers to cut down on the practice.
The change represents 25% of prior authorization requirements for 16.5 million commercial enrollees, the health insurance company announced in a news release Thursday. Fewer than 4% of procedures are now subject to prior authorization for commercial policyholders, according to the company.
“We’ve listened attentively to our clinician partners and are deliberately making these changes as a result,” Cigna Chief Health Officer Dr. David Brailer said in the news release.
Cigna is lifting prior authorization requirements for nearly 200 genetic testing services, more than 100 surgical procedures, and a range of diagnostics and durable medical equipment, a company spokesperson wrote in an email. Cigna has removed more than 1,100 prior authorization requirements since 2020, the news release said. Cigna also announced plans to scrap precertification in its Medicare Advantage plans for an additional 500 codes this year.
ProPublica reported in March that Cigna utilizes software to analyze prior authorizations requests without human reviews, which Cigna has denied. The company is defending itself against a proposed class-action lawsuit over the matter in the U.S. District Court for the Eastern District of California.
Providers, government authorities and patients are increasingly criticizing health insurance company prior authorization demands for a plethora of products and services, prompting Cigna, UnitedHealth Group and others to scale back the practice.
The Centers for Medicare and Medicaid Services has proposed or implemented policies this year to curb prior authorizations, such as dictating that Medicare, Medicaid and health insurance exchange carriers issue decisions more quickly and justify denials.
Congress also has tackled the issue. The House Ways and Means Committee approved legislation last month that would require Medicare Advantage insurers to process prior authorization requests electronically and in real-time. The Senate Homeland Security and Governmental Affairs Committee sent letters in May to Aetna parent company CVS Health, Humana and UnitedHealth Group requesting documentation of their prior authorization processes, including whether they employ artificial intelligence.
UnitedHealth Group announced in March that it would trim products and services subject to prior authorization by 20% beginning next month. The company also plans by next year to roll out a “gold card” program eliminating most prior authorization requirements for doctors who have high approval rates.
Humana uses electronic processes to speed prior authorization requests and has partnered with electronic health record companies to streamline the process, the company has said.
