Doc groups say payer promises not enough to address care denials

The Medical Group Management Association and over a dozen other doc groups say payer promises are not enough to address ongoing issues with care denials and delays. 

On June 23, over 50 healthcare insurers and industry lobbying group AHIP issued a joint announcement saying they planned to reduce the burden of prior authorization for imaging and other services. The pledge was strictly voluntary and comes as both physicians and lawmakers have pushed a legislative fix to address this utilization management tactic in Medicare Advantage. 

MGMA and others who are part of the “Regulatory Relief Coalition” on June 28 urged Congress to continue pushing forward with the Improving Seniors’ Timely Access to Care Act. The bill has garnered widespread support from both the U.S. House and Senate, along with numerous medical associations. 

“Promises from the insurance industry do not guarantee relief,” the coalition said in a statement. “The insurers’ commitments mirror many of the reforms long championed by [the Regulatory Relief Coalition], as well as key beneficiary protections advanced by CMS in 2024. However, many of these same insurers promised in a 2018 consensus statement—but failed to deliver—meaningful change or beneficiary protections. In fact, since that 2018 statement, the burden of prior authorization has only increased.”

MGMA—which represents over 15,000 medical groups across radiology and other specialties—highlighted a 2024 report from the Senate, which found that UnitedHealthcare’s denial rate for prior authorization in post-acute care “rose sharply” post-pandemic. In 2019, the figure was 8.7%, climbing to 22.7% as of 2022. In another analysis, KFF found Medicare Advantage insurers denied about 6.4% of PA requests in 2023, up from 5.7% in 2019. 

Recently, insurers’ pledge for real-time decisions on 80% of prior authorizations by 2027 is one of the key provisions in the Seniors’ Act, they added. But the recent commitment does not include the same transparency measures, such as data sharing metrics or additional oversight—“reforms necessary to ensure plans are held accountable for denials.” 

“Real government oversight and transparency, as afforded by the Seniors’ Act, will ensure that insurers are held accountable. RRC calls on Congress to advance the Seniors’ Act this year to protect the 35 million Americans on Medicare Advantage,” the letter concluded. 

Other members of the coalition include the American Academy of Family Physicians, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and the American Osteopathic Association. They also highlighted a June 24 message from members of Congress, advocating for passage of the Seniors Act, despite the payer promise. 

"We applaud these commitments, which aim to improve healthcare access for millions of Americans by easing the Medicare Advantage prior authorization process," politicians said. "We encourage our House and Senate colleagues to carry this momentum forward and to pass our life-changing legislation, the Improving Seniors’ Timely Access to Care Act, to ensure this progress becomes law."