Cigna removing some prior authorization requirements

Health insurer Cigna announced that it will remove prior authorization requirements for 25% of medical services, amounting to more than 600 codes. The company said it has removed prior auths on more than 1,100 medical services since 2020. There was no indication of how many codes may have added prior auth requirements in that timeframe.

Cigna removing some prior authorization requirements: ©Sdx15 - stock.adobe.com

"Our goal is to help keep patients safe, improve health outcomes, and make care more affordable, and this important step will enable us to do that while removing administrative burdens on the health care system," said David Brailer, MD, executive vice president and chief health officer, The Cigna Group, in a statement. "We've listened attentively to our clinician partners and are deliberately making these changes as a result. We will continue to hold ourselves accountable for this important work and look forward to building on this momentum in the future."

According to the company, with this update, prior authorization now applies to less than 4% of medical services for most Cigna Healthcare customers. Cigna says it will also remove prior authorization for nearly 500 additional codes for Medicare Advantage plans later this year. Cigna has been accused by the Justice Department of Medicare Advantage fraud.

Prior authorizations in Medicare Advantage have come under government scrutiny after studies found that some payers were requiring them for medical services that should not have them. Both CMS and Congress have pushed for prior auth reforms.

"Prior authorizations are an important step to ensure patient safety and affordability, but clinicians and health plans alike agree that more can be done to reduce the administrative burden on clinicians," said Scott Josephs, MD, chief medical officer, Cigna Healthcare, in a statement.

Cigna joins UnitedHealth, which also said it plans to reduce the use of prior authorizations by 20% for some non-urgent surgeries and procedures.