Big changes to your insurance could affect how fast you get care
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Some recent updates are quietly shaking up the way health coverage works—and they might be just what many have been waiting for.
If you’ve ever dealt with long delays just to get a prescription, scan, or basic treatment approved, you're far from alone.
There’s now a major push from some of the biggest names in the industry to fix the system that’s been frustrating patients and their doctors for years.
These moves aren’t taking effect all at once, but they’re coming—and they could change how Americans experience care.
Several major US health insurers announced plans to overhaul the widely criticized prior authorization process.
This system has required medical providers to get approval before certain services—like scans, hospital stays, or prescriptions—can be covered.
Although it's meant to prevent unnecessary costs, the system has long caused delays in care and added pressure to both patients and health professionals.
Companies such as UnitedHealthcare and Aetna, owned by CVS Health, say they’ll now reduce the number of services that need this kind of approval.
They’ve also promised to move approvals to a faster and fully digital system.
Instead of relying on slow paperwork, faxes, or phone calls, real-time electronic decisions will be introduced for more cases.
If it all works as planned, the new tools will eliminate unnecessary waiting and back-and-forths.
Another key part of the reform: approvals will carry over when someone switches plans.
That means people with ongoing treatments won’t need to start the process all over again.
Also read: Hidden gaps in health insurance networks are hurting patients—but improvements have yet to show results
This news could bring real relief to Americans who rely on health plans through employers, individual marketplaces, Medicare Advantage, or Medicaid.
Most of these changes are set to roll out gradually through 2026 and 2027.
In interviews, doctors shared how the system has harmed patients emotionally and physically.
Dr. Ashley Sumrall, an oncologist, explained, “There's a term that we use called “scanxiety,” and it's very real.”
She’s seen firsthand how the wait for approval on something like an MRI can leave patients in distress.
Even when approvals eventually come through, the delays mean time lost in evaluating whether treatments are working.
Sumrall pointed out that each insurance provider has a different process—creating confusion and wasted time.
“For years, the companies have been unwilling to compromise, so I think any step in the direction of standardization is encouraging,” she said.
A recent Kaiser Family Foundation report highlighted how widespread the issue is.
It found that nearly every Medicare Advantage enrollee faces prior authorization requirements, particularly for more costly procedures.
In 2023 alone, insurers denied about 6 percent of all these requests.
That might seem low at first glance—but when millions of claims are involved, it adds up fast.
Doctors also feel the strain, spending hours every week chasing approvals instead of treating patients.
During his Senate confirmation hearing in March, Dr. Mehmet Oz called prior authorization “a pox on the system.”
He argued that it drives up costs and pulls focus away from actual patient care.
Also read: Primary Insurance falling short? Here’s why secondary coverage might be your best move
Many of these changes have been influenced by recent pressure from patients, lawmakers, and healthcare leaders.
Public frustration has been building for years, and it reached a boiling point after a tragic, high-profile incident involving a health industry executive.
In response, insurers are now pledging that all denied claims will be reviewed by licensed medical professionals.
Previously, many denials were handled by administrative staff with little or no medical training.
Experts say these reforms may not fix everything—but they are a strong step in the right direction.
Tom Baker, a professor of law at the University of Pennsylvania, said that “If these measures are effective, Americans should have to wait less time to receive necessary procedures, and health care providers should have more time to spend with patients.”
He also noted the difficult balance insurers must maintain: keeping access smooth while still controlling skyrocketing healthcare costs.
Michael Anne Kyle, a healthcare assistant professor, added that administrative burdens have only worsened as costs climb.
“We're sort of trapped between care being unaffordable and then these nonfinancial barriers and administrative burdens growing worse,” she said.
These upcoming changes aim to ease that trap—but it’s clear more improvements may still be needed in the future.
If successful, the new systems could relieve stress for patients, doctors, and insurers alike.
But until the rollout is complete, patients are still encouraged to advocate for themselves.
Read next: Are you at risk? Representative reveals how UnitedHealthcare might be taking advantage of Medicare
Have you or someone you love faced delays due to prior authorization? Were you able to get the care you needed, or did the red tape get in the way? The community wants to hear your stories—share your experience or thoughts in the comments below. Let’s keep the conversation going.
If you’ve ever dealt with long delays just to get a prescription, scan, or basic treatment approved, you're far from alone.
There’s now a major push from some of the biggest names in the industry to fix the system that’s been frustrating patients and their doctors for years.
These moves aren’t taking effect all at once, but they’re coming—and they could change how Americans experience care.
Several major US health insurers announced plans to overhaul the widely criticized prior authorization process.
This system has required medical providers to get approval before certain services—like scans, hospital stays, or prescriptions—can be covered.
Although it's meant to prevent unnecessary costs, the system has long caused delays in care and added pressure to both patients and health professionals.
Companies such as UnitedHealthcare and Aetna, owned by CVS Health, say they’ll now reduce the number of services that need this kind of approval.
US health insurers announced plans to overhaul the widely criticized prior authorization process. Image Source: National Cancer Institute / Unsplash
They’ve also promised to move approvals to a faster and fully digital system.
Instead of relying on slow paperwork, faxes, or phone calls, real-time electronic decisions will be introduced for more cases.
If it all works as planned, the new tools will eliminate unnecessary waiting and back-and-forths.
Another key part of the reform: approvals will carry over when someone switches plans.
That means people with ongoing treatments won’t need to start the process all over again.
Also read: Hidden gaps in health insurance networks are hurting patients—but improvements have yet to show results
This news could bring real relief to Americans who rely on health plans through employers, individual marketplaces, Medicare Advantage, or Medicaid.
Most of these changes are set to roll out gradually through 2026 and 2027.
In interviews, doctors shared how the system has harmed patients emotionally and physically.
Dr. Ashley Sumrall, an oncologist, explained, “There's a term that we use called “scanxiety,” and it's very real.”
She’s seen firsthand how the wait for approval on something like an MRI can leave patients in distress.
Even when approvals eventually come through, the delays mean time lost in evaluating whether treatments are working.
Sumrall pointed out that each insurance provider has a different process—creating confusion and wasted time.
“For years, the companies have been unwilling to compromise, so I think any step in the direction of standardization is encouraging,” she said.
A recent Kaiser Family Foundation report highlighted how widespread the issue is.
It found that nearly every Medicare Advantage enrollee faces prior authorization requirements, particularly for more costly procedures.
In 2023 alone, insurers denied about 6 percent of all these requests.
That might seem low at first glance—but when millions of claims are involved, it adds up fast.
Doctors also feel the strain, spending hours every week chasing approvals instead of treating patients.
During his Senate confirmation hearing in March, Dr. Mehmet Oz called prior authorization “a pox on the system.”
He argued that it drives up costs and pulls focus away from actual patient care.
Also read: Primary Insurance falling short? Here’s why secondary coverage might be your best move
Many of these changes have been influenced by recent pressure from patients, lawmakers, and healthcare leaders.
Public frustration has been building for years, and it reached a boiling point after a tragic, high-profile incident involving a health industry executive.
In response, insurers are now pledging that all denied claims will be reviewed by licensed medical professionals.
Previously, many denials were handled by administrative staff with little or no medical training.
Experts say these reforms may not fix everything—but they are a strong step in the right direction.
Tom Baker, a professor of law at the University of Pennsylvania, said that “If these measures are effective, Americans should have to wait less time to receive necessary procedures, and health care providers should have more time to spend with patients.”
He also noted the difficult balance insurers must maintain: keeping access smooth while still controlling skyrocketing healthcare costs.
Major US health insurers will scale back and standardize the prior authorization system that has delayed care for many Americans. Image Source: Towfiqu Barbhuiya / Unsplash
Michael Anne Kyle, a healthcare assistant professor, added that administrative burdens have only worsened as costs climb.
“We're sort of trapped between care being unaffordable and then these nonfinancial barriers and administrative burdens growing worse,” she said.
These upcoming changes aim to ease that trap—but it’s clear more improvements may still be needed in the future.
If successful, the new systems could relieve stress for patients, doctors, and insurers alike.
But until the rollout is complete, patients are still encouraged to advocate for themselves.
Read next: Are you at risk? Representative reveals how UnitedHealthcare might be taking advantage of Medicare
