Preauthorization

TMA Joins New Statewide Insurance Reform Coalition - 11/08/2024

The newly created Texas Coalition for Patients calls for “common sense policy reforms” around health insurance, including greater transparency around prior authorizations. TMA leaders say the organization will augment medicine’s related advocacy.

Health Plans Begin Implementing Prior Auth Exemption Process - 11/07/2024

With an Oct. 1 deadline on the horizon, health plans have begun implementing Texas’ new prior authorization exemption process requiring them to issue the first so-called “gold cards” by that date.

Send TMA Your Prior Authorization Nightmare Stories - 11/06/2024

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ experience with insurance companies’ prior authorization requirements and approval processes.

United Launches National ‘Gold Card’ Program - 09/17/2024

UnitedHealthcare announced the launch of what it’s calling a national “gold card” program, which purports to allow physicians to bypass the prior authorization process and is set to begin Oct. 1.

Medicine to Feds: Back Off Prior Authorization Requirements - 08/09/2024

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.

Aetna Scraps Required Prior Auth for Cataract Surgery - 05/15/2024

Organized medicine’s efforts across the nation to torpedo or curb prior authorization recently got a small but encouraging boost when Aetna rescinded its year-old preauthorization requirement for cataract surgeries.

CMS to Test Prior Auth Requirements for Certain ASC Procedures - 04/10/2024

Texas physicians soon may encounter new Medicare prior authorization requirements for certain services that double as cosmetic procedures when provided at an ambulatory surgical center.

Shielding the Gold Card Law: TMA Fights to Guarantee Gold Card is Implemented as Intended - 04/09/2024

Texans earned one of its most prolific victories with its prior auth exemption law but still fights to guarantee it's implemented as intended.

Prior Auth Processes to Streamline Under Medicare Advantage, Other Federal Programs - 01/23/2024

Physicians who care for patients enrolled in federal health plans can expect shorter prior authorization response times and other process improvements in coming years, thanks to longstanding advocacy by the Texas Medical Association and others in organized medicine.

No Prior Auth Required for Generic Asthma Meds Following Medicaid Formulary Change - 12/19/2023

As of Dec. 15, physicians can prescribe generic asthma medications previously listed as non-preferred on the Medicaid preferred drug list without needing prior authorization.

United Will Eliminate Prior Authorization Requirements for Certain Procedures - 08/11/2023

Physicians have long complained about onerous prior authorization requirements, which often delay care and sometimes have catastrophic consequences. One payer seems to be listening.

Federal Prior Auth Bill Filed in Congress - 07/25/2023

U.S. Rep. Michael C. Burgess, MD (R-Lewisville), is following his fellow Texas physicians’ lead on curbing insurers’ hassle-laden prior authorization burdens, introducing a federal bill similar to the “gold-card” law the Texas Medical Association proposed and championed into law at the state level.

Physician-Led Results: Insurance - 06/21/2023

TMA can count several insurance-related legislative wins this session, including an additional prior authorization reform for vulnerable patients and new protections against bad health plan practices for patients and physicians alike.

United Ties New “Advance Notification” of GI Procedures to Gold-Carding - 06/12/2023

Rather than go through with its controversial prior authorization policy for gastroenterology endoscopy procedures on June 1, UnitedHealthcare (UHC) announced an equally concerning “advanced notification” pilot program requiring early notification and the submission of substitute documentation for certain gastrointestinal procedures.

TMA Joins Fight Against Prior Auth for Gastroenterology Services - 05/15/2023

The Texas Medical Association joined roughly 200 national and state medical specialty societies, patient organizations, foundations, and physician groups in a widespread call urging UnitedHealthcare (UHC) to halt its nationwide policy requiring prior authorization for gastroenterology endoscopy services that take place on or after June 1.

CMS Proposal Could Alleviate Prior Auth Stress in Federal Programs - 04/26/2023

The Texas Medical Association’s years of lobbying for prior authorization reform paid off with the passage of Texas’ “gold-card” law in 2021. Now the framework is gaining traction at the federal level, where a proposal would ease onerous preapproval requirements under certain public health plans.

Survey: Physicians Overwhelmingly Say Prior Authorizations Lead to Waste, Patient Harm - 03/29/2023

Amid the Texas Medical Association's ongoing advocacy for prior authorization reforms at state and federal levels, yet another survey underscores the patient and financial harms that result from these onerous requirements.

United To Require Prior Auth for Gastroenterology Services - 03/28/2023

Citing overutilization, a new nationwide UnitedHealthCare policy piles on to physicians’ prior authorization hassles, now requiring preappovals for many gastroenterology endoscopy services that take place on or after June 1.

TDI Eases Prior Authorization Request Process for Prescription Renewals - 03/20/2023

After a three-year effort, the Texas Medical Association recently secured a form change that allows physicians to bypass the most onerous part of prior authorization requests when renewing an existing prescription.

Medicine Backs Proposed Medicare Prior Authorization Reforms - 02/24/2023

Physicians caring for Medicare patients soon may find relief from onerous prior authorization requirements that frequently delay, discourage, or drive up the costs of care, thanks to proposed regulations governing Medicare Advantage (Part C) and prescription drug (Part D) plans.

“Gold Card” Final Rules Heed Some, But Not All, TMA Recommendations on Prior Auth Exemption Process - 09/09/2022

Texas physicians have anxiously awaited – and advocated for – relief from onerous prior authorizations, which is now closer than ever.

What's Next for Prior Authorization: Texas' 'Gold Card' Law Winds Through Rulemaking - 06/29/2022

Physician advocates, alongside the Texas Medical Association, are looking to this fall’s legislative races as they monitor the rulemaking underway to implement the "Gold Card" law and prepare to push for additional reforms during the 2023 legislative session that kicks off in January.

Imaging Contrast Shortage Highlights Need for Relaxed Prior Auth - 06/27/2022

A shortage of iodinated contrast media resulting from recent COVID-19 lockdowns in China has put a focus on prior authorization barriers that unnecessarily impede the imaging services patients need to ensure timely care.

Physician-Led Results: Grassroots Advocacy Paid Off in Tangible Wins at the Capitol - 06/15/2022

Texas physicians made the most of an extraordinary, scaled-back session of the Texas Legislature in 2021. They helped pass laws to curb prior authorization hassles; keep physicians from incurring new practice costs; install liability protections for future pandemics like COVID-19; extend postpartum Medicaid coverage for new mothers; and keep graduate medical education (GME) fully funded. And so much more.

Medicare Advantage Plans Wrongly Denied Prior Auth, Payment Requests, Fed Report Shows - 05/06/2022

About 13% of prior authorization denials in Medicare Advantage likely prevented or delayed necessary care, according to an analysis by the U.S. Department of Health and Human Services Office of the Inspector General. The report also found that nearly one-fifth of the time Medicare Advantage plans denied payment requests when the request met Medicare coverage rules and should have earned approval.