U.S. health insurers have made it easier for doctors to get approval before providing certain types of treatment, industry groups said, calling it a sign of progress toward alleviating burdensome delays for patients.

Major health plans said they collectively removed thousands of prior authorization requirements for medical procedures since they pledged to cut red tape last year. About 11% of the approvals they mandated in 2024 are no longer in place, according to data from two leading insurance trade associations. That would mean about 6.5 million fewer requests in Medicare and some commercial plans, holding everything else constant, the group said. The data don’t cover prior approvals for prescription drugs.

Health insurers have long faced calls to fix the prior approval process in which insurers must green-light doctors’ orders before patients get treatment. Almost half of insured adults said it’s led to a delay, denial or a different treatment than what was prescribed, according to a survey from health researcher KFF. More than a quarter of doctors in an American Medical Association survey said prior authorization led to hospitalization or other harm.

Health plans are making progress on “speeding up patient access to appropriate care while maintaining important protections against waste, fraud and abuse,” according to an announcement to be published Tuesday by the industry groups AHIP and the Blue Cross Blue Shield Association. Major insurers including UnitedHealth Group Inc., Elevance Health Inc., Cigna Group, CVS Health Corp. and Centene Corp. made voluntary commitments to improve the process under pressure from the Trump administration.

In addition to reducing the number of approvals required, insurance companies say they’ve taken steps to streamline the process. For example, insurers will now honor existing authorizations for 90 days when a patient switches plans, the groups said. They’ve also tried to make the language on their responses clearer.

The insurers aimed to remove requirements for low-cost, high-volume services, with many examples in imaging, cardiology as well as ear, nose and throat care, the groups said. CVS’ Aetna is bundling prior authorization requests, so a single one for in-vitro fertilization, for example, would cover procedures and drugs. UnitedHealth and Humana Inc. both started “gold card” programs where doctors who have a track record of sticking to medical guidelines face fewer authorizations.

The changes are “good first steps” toward making care decisions in real time, said Shawn Gremminger, chief executive officer of the National Alliance of Healthcare Purchaser Coalitions, which represents employer groups. Employers must keep pushing for improvements to reduce “friction for employees, their families and clinicians,” he said in a news release from the insurance trade groups.

Delays

Prior approvals have been a point of contention for decades. Archelle Georgiou was chief medical officer at UnitedHealthcare in 1999 when the company removed all prior authorizations amid intense backlash to the practice. She said dropping the requirements at UnitedHealthcare was ultimately a cost-saving measure, because the company spent millions of dollars to review requests that were overwhelmingly approved.

Those savings were put into efforts to coordinate care, for example, by reducing how often patients were readmitted to the hospital. “The strategy was to improve care and decrease our administrative costs,” she said. But as medical costs increased in the 2000s, the company reintroduced prior authorizations.

Georgiou, who left UnitedHealth in 2007 and now works as a strategic adviser to health-care companies, said insurers aren’t moving fast enough to fix the problem. “You should have an obligation to make it work well from the get-go,” she said in an interview before seeing the industry data released Tuesday. Prior approval delays can prolong patients’ suffering, she said. “The system shouldn’t create those delays,” she said.

New data

The industry’s progress update comes days after insurers were forced to release fresh data on how often they denied requests for care last year in Medicare, Medicaid and Affordable Care Act plans.

The disclosure was mandated by a federal policy finalized in 2024, with a March 31 deadline. The data broadly show that the largest insurers typically approve a high share of the care requested, though for most companies, the information is splintered into dozens of reports for individual plans, making it difficult to see the whole picture. It also doesn’t cover prescription drug requests or data for the employer health plans most working-age people have.

The data, and the gaps in it, make it hard to interpret broadly which companies have the most burdensome authorization requirements. It’s also impossible to tell from the disclosures whether denials are more common for expensive and time-sensitive treatments like cancer care or organ transplants.

Still, the data showed wide variation in how often insurers require prior authorizations and how frequently they deny the requests. Bloomberg News analyzed data on the largest Medicare Advantage contracts for each of the five big, publicly traded Medicare insurance companies — plans that collectively cover more than 7 million people. All were the same type of plan, preferred provider organizations that are meant to give enrollees greater choice of doctors.

In their largest Medicare contracts in 2025, Centene and Humana required more than twice as many standard authorizations per member than UnitedHealth, the data show. While it had fewer requests per member, UnitedHealth denied a greater share of the requests it required than its rivals. (Two of the companies, Elevance and CVS’s Aetna, didn’t disclose the number of requests.)

Across all companies, appeals tended to overturn denials more than half the time, or as frequently as 94% of the time for Centene.

Though denials are often overturned on appeal, most people don’t take that step. The largest Medicare Advantage contracts for Humana, UnitedHealth and Aetna together denied 750,000 standard prior authorization requests in 2025, the data show. Only 6% of those were appealed, but those appeals succeeded in overturning the denial more than half the time.

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