Following in the footsteps of UnitedHealthcare, Cigna announced Thursday that it is removing 25% of medical services from prior authorization in a bid to simplify the experience for patients and providers. However, unlike UHC, the Bloomfield, Connecticut-based insurer said it is not including imaging on the list.
The tally covers more than 600 codes, spanning a wide range of tests, treatments and medical equipment. They include 100 surgical procedures and dozens more services in genetic testing, with durable medical equipment, orthoses and prosthetics also impacted. However, no imaging codes made the cut, a company spokesperson told Radiology Business.
“Our goal is to help keep patients safe, improve health outcomes, and make care more affordable, and this important step will enable us to do that while removing administrative burdens on the healthcare system,” David Brailer, MD, executive VP and chief health officer of the Cigna Group, said in an Aug. 24 announcement. “We've listened attentively to our clinician partners and are deliberately making these changes as a result. We will continue to hold ourselves accountable for this important work and look forward to building on this momentum in the future.”
Cigna estimated that it has removed prior authorization for more than 1,100 medical services since 2020. Also referred to as “precertification,” the review is meant to help “protect patient safety and improve affordability by increasing adherence to evidence-based standards of care,” Cigna said. The insurer estimated that less than 4% of medical services are impacted by prior authorization for most customers. Cigna also plans to remove another 500 codes under its Medicare Advantage plans later this year.
Politicians and providers have contended that prior authorization often serves as an unnecessary roadblock that delays or prevents patients from receiving essential services. Cigna has faced criticism over its use of PA, including a class action lawsuit filed in July, alleging the company violated the law by denying claims for imaging and other healthcare services in bulk. Cigna previously stopped requiring prior authorization for certain CT imaging exams in 2021.
In a separate fact sheet attached to the announcement, the insurer explained its rationale for requiring precertification for some imaging exams.
“Prior authorization is predominantly focused on complex treatments, tests and certain medications—for example, to help a patient avoid unnecessary exposure to radiation that puts them at increased risk of cancer or to manage opioid prescriptions for at-risk patients,” Cigna said. “It has proven to be successful. One data point that we are proud of: Since 2014, prior authorizations have led to the potential avoidance of over 500 new cancer cases among Cigna customers by preventing or limiting radiation exposure from medically unnecessary CT scans.”
UnitedHealthcare announced its own round of prior authorization reductions on Aug. 1, covering 20% of overall procedural volumes and including over 60 radiology services under its commercial plans.
Radiology faces the heaviest burden from prior authorization, behind only radiation oncology and cardiology, a JAMA Health Forum analysis found.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.