Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
Going through this right now. Had to change insurance because of new job, this new insurance is fighting tooth and nail to not pay for the medicine I’ve been taking for years that keeps my Crohn’s under control. I’ve been without it for over a hundred days, and things are starting to backslide.
Literally, I’m getting sicker as they waste my time. They’re shit genuinely sickening.
Name and shame
For what it’s worth, contact your employer’s benefits coordinator. They can often slap the insurance company around since they’re the people essentially paying the bill.