Humana commits to eliminating prior authorization for certain CT, MR imaging exams

Health insurer Humana Inc. on Tuesday said it is committing to the elimination of prior authorization for certain CT and MR imaging exams. 

Payers have faced increased scrutiny in recent years around such preapprovals, forcing physicians to gain their green light before delivering care. Amid this climate, over 50 health insurers in June pledged to reduce the prior authorization burden for imaging and other services. 

Humana said it is now building on that promise. The Louisville, Kentucky-based insurer plans to eliminate approximately one-third of prior authorizations for outpatient services by Jan. 1. This will include diagnostic offerings such as colonoscopies and transthoracic echocardiograms, along with “select CT scans and MRIs.” 

“Today’s healthcare system is too complex, frustrating and difficult to navigate, and we must do better,” Jim Rechtin, MBA, president and CEO of Humana—who previously led multispecialty radiology services provider Envision Healthcare—said in a statement July 22. “We are committed to reducing prior authorization requirements and making this process faster and more seamless to better support patients, caregivers, physicians and healthcare organizations.”

In addition, Humana also is committing to establishing a “faster, more streamlined” process for approvals by Jan. 1. This will include providing a decision within one business day on at least 95% of all “complete” electronic prior authorization requests. Currently, the payer claims it does so within one business day on over 85% of outpatient procedures. 

Humana also will create a new “national gold card program” for physicians in 2026. The initiative will waive prior authorization requirements for certain items and services, when requested by providers who have a “proven record of submitting coverage requests that meet medical criteria.” Humana also will increase transparency around its prior authorization decisions by publicly reporting metrics such as the number of requests approved, denied and average wait time in between. And finally, the insurer will work to reduce the number of requests handled via fax or telephone while bolstering interoperability so docs can process requests via existing workflows. 

The pledge comes as radiologists have pushed Humana to modify its coverage policies related to certain interventional services. In May, the Society of Interventional Radiology urged the insurer to update a policy rejecting coverage for peripheral nerve stimulation therapy, a technique that uses electrical pulses to disrupt pain signals to the brain. Plus, last year SIR and others expressed “profound objection” to Humana labeling closed-loop spinal cord stimulation as “experimental” and “unproven.” 

Members of Congress in May proposed the Improving Seniors’ Timely Access to Care Act to simplify prior authorization processes under the Medicare Advantage program. Humana said Tuesday it supported the bipartisan bill when introduced under the past two Congresses and still does after its recent reintroduction.