AHIP, the national trade association representing the health insurance industry, and the Blue Cross Blue Shield Association recently announced a set of “voluntary commitments” to “streamline” prior authorization and “improve patient outcomes.” Major insurers including Aetna, Centene, Cigna, Elevance Health, Humana, and UnitedHealthcare have signed on.
These commitments appear to put more guardrails on how insurers use prior authorization. In reality, they largely repeat existing obligations and may simply be a strategic attempt to deflect growing public criticism of insurers’ abuse of prior authorization to deny or delay care.
These commitments were developed during a roundtable hosted by Dr. Mehmet Oz. Notably, it’s unclear whether any consumers, consumer groups, or provider associations participated in shaping them. Any lack of broad stakeholder representation raises concerns about whether the commitments reflect the interests of the people most affected by prior authorization policies.
AHIP also released a policy brief to accompany the announcement, reasserting the importance of prior authorization as a tool for reducing “unnecessary” health care spending and as a “critical safeguard in patient care.” Yet, a large and growing body of research shows that prior authorization is a primary way insurers control costs while tripping up beneficiaries in red tape. This misrepresentation of harm calls into question the credibility of the initiative as whole.
Against that backdrop, a closer look at the commitments reveals that several simply echo the existing requirements already baked into federal regulation, including in the CMS Interoperability and Prior Authorization Rule (“Rule”) finalized in January 2024. For example, the pledge to adopt FHIR-based technology for electronic submission by January 1, 2027, is not new. That deadline is already mandated under the Rule for many plans. Likewise, the promise to improve transparency by explaining denials in plain language and providing appeal guidance simply restates baseline requirements found in the Rule and required by the Affordable Care Act.
While some commitments mirror existing requirements that lend a degree of accountability (if enforced), other so-called “new” commitments totally lack meaningful oversight or accountability, relying entirely on voluntary compliance. For example, the pledge to reduce prior authorization volume by 2026 only “as appropriate” for each plan’s local market lets insurers set their own goals without standards, oversight, or consequences. These kinds of statements may sound patient-centered, but are meaningless without regulatory oversight. Another commitment – to have clinicians review denials – is already described by AHIP as an industry-wide “existing norm.” Even if that is true, there is no standard requiring plans to disclose who is making decisions, leaving consumers in the dark and unable to know whether the promise is actually being followed.
These same corporations made similar promises in 2018 and again in 2023. At the time, they vowed to reduce prior authorization and increase transparency. But without any enforcement, those promises went nowhere and the volume of prior authorization increased.
Other commitments are more limited than they appear. The pledge to honor existing authorizations for 90 days when a member switches plans only applies if the person has already started the approved course of treatment and only if the benefit is covered and provider is in-network under the new plan. That’s far from a robust continuity of care guarantee.
The commitment to process 80% of prior authorization requests in “real time” by 2027 also raises concerns. It lacks a clear definition of “real time” and creates incentives for speed over careful, individualized review. In practice, efforts to accelerate processing often rely on overworked clinicians or algorithmic tools that cut corners. A former Cigna medical director, for example, said that she and other doctors were pressured to rush through claim reviews without fully examining patient records. Her superiors were “more concerned about being fast than being right.” We have already seen how automation and AI tools can contribute to opaque, inconsistent, and clinically inappropriate denials. AHIP claims AI isn’t used to deny care without clinician input, but mounting evidence shows otherwise. Without meaningful guardrails, transparency, or independent oversight, this pledge risks increased reliance on the very technologies that have undermined trust in prior authorization.
Ultimately, this voluntary framework follows the same playbook and seems more focused on protecting insurers than helping patients. HHS praised the “flexibility” of the initiative, framing it as a balanced approach to reducing burden while maintaining care quality. HHS and Dr. Oz “applaud[ed] these voluntary actions by the private sector,” noting that this “is how these types of issues should be solved.” This framing misses the point. We don’t need more flexibility for insurers. We need enforceable rules – real tools like auditing, independent oversight, external medical reviews, and public reporting requirements – and penalties for noncompliance when delays or denials cause harm. Otherwise, all we have are toothless commitments. Empty promises with no bite.
