Primetime Living 11.26.25 - Flipbook - Page 13
A Special Advertising Section of Baltimore Sun Media Group | Wednesday, November 26, 2025 13
and CEO Mike Tuffin.”
KFF Health News published an article in September 2025, titled Deadly
Denials, covering the same topic. “Nearly
seven months after the fatal shooting
of an insurance CEO in New York drew
widespread attention to health insurers’
practice of denying or delaying doctor-ordered care, the largest U.S. insurers
agreed Monday to streamline their often
cumbersome preapproval system.
“Dozens of insurance companies,
including Cigna, Aetna, Humana and
UnitedHealthcare, agreed to several measures, which include making fewer medical procedures subject to prior authorization and speeding up the review process.
Insurers also pledged to use clear language when communicating with patients
and promised that medical professionals
would review coverage denials.”
“The pledge is not a mandate,”
Mehmet Oz, administrator of the Centers
for Medicare & Medicaid Services, said
during a news conference. “This is an
opportunity for the industry to show
itself.”
Oz said that insurance preapprovals for
some procedures are appropriate, while
others would benefit most Americans,
including those with commercial or private coverage, Medicare Advantage and
Medicaid managed care.
But health policy analysts say prior
authorization – a system that forces
some people to delay care or abandon
treatment –may continue to pose serious health consequences for affected
patients.
That said, many people may not notice
a difference, even if insurers follow
through on their new commitments.
“So much of the prior authorization
process is behind the black box,” said
Kaye Pestaina, director of the Program
on Patient and Consumer Protections
at KFF, a health information nonprofit
that includes KFF Health News. “Often,”
she said, “patients aren’t even aware
that they’re subject to prior authorization
requirements until they face a denial.”
“There’s no question that health insurers have a reputation problem,” said
Robert Hartwig, an insurance expert
and a clinical associate professor at the
University of South Carolina.
The pledge shows that insurers are
hoping to stave off “more draconian”
legislation or regulation in the future,
Hartwig said.
But government interventions to
improve prior authorization will be used
“if we’re forced to use them,” Oz said
during the news conference. “The admin-
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istration has made it clear we’re not going
to tolerate it anymore,” he said. “So,
either you fix it or we’re going to fix it.”
Reliability of AI
Continued on page 20
