HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz Host a Press Conference Discussing a Breakthrough with Health Insurers Regarding 'Prior Authorization' Policy

HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz

RFK Jr. Announces a “Health Insurance Breakthrough” Impacting Nearly 260 Million Americans. Kennedy described this as a monumental achievement—a breakthrough years in the making. Here’s what is changing and why it could save you time, stress, and money.

 
 

In a press conference hosted today, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced a landmark agreement with the nation’s largest health insurers to tackle the number one healthcare problem plaguing hundreds of millions of Americans: prior authorization.

Prior authorization is the requirement for doctors and patients to get advance approval from insurance companies BEFORE certain treatments, tests, or procedures are covered. It was meant to control costs, but for 85% of Americans, it’s become a serious barrier to care.

“Doctors like myself are continually struggling with this issue,” Dr. said, explaining how the bureaucratic process not only delays treatment but deeply frustrates both providers and patients.

In 2023 alone, Medicare Advantage (which covers about 32 million people) initially denied 3.2 million prior authorization requests. Dr. Oz made clear these are not just numbers: they represent “individuals who often, in the most vulnerable time in their lives, needed something done and it was denied.”

The burden also falls heavily on physicians. On average, doctors spend 12 hours per week on paperwork, handling about 40 prior authorization cases weekly. Dr. Oz said it contributes to burnout, slows down care, and “erodes public trust in the health care system.”

@VigilantFox wrote on ‘X.’ But under RFK Jr.’s leadership, things are changing for the better.

An HHS press release announced today that “health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers.”

These changes aim to ensure that patients and their doctors no longer have to battle insurance companies just to access common treatments like imaging, outpatient surgery, or physical therapy.


www.hhs.gov

HHS Secretary Kennedy, CMS Administrator Oz Secure Industry Pledge to Fix Broken Prior Authorization System.


The cooperating insurers include UnitedHealthcare, Aetna, Blue Cross Blue Shield Association, Humana, Kaiser Permanente, The Cigna Group, Centene Corporation, Elevance Health, Highmark Health, CareFirst BlueCross BlueShield, and GuideWell, along with the industry trade group AHIP.

Participating insurers (which cover nearly 80% of Americans) have committed to:

Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces.

  • Reduce the volume of medical services subject to prior authorization by January 1, 2026.

  • Honor existing authorizations during insurance transitions to ensure continuity of care.

  • Enhance transparency and communication around authorization decisions and appeals.

  • Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.

  • Ensure medical professionals review all clinical denials.

“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” said Dr. Mehmet Oz.

"To read the full post from @VigilantFox, click HERE!"

Theo Edwards

Theo Edwards has over twenty years of diverse Information Technology experience. He spent his days playing with all things IBMi, portal, mobile application, and enterprise business functional and architectural design.

Before joining IBM as Staff Software Engineer, Theo worked as a programmer analyst and application specialist for businesses hosting eCommerce suite on IBMi platform. He has been privileged to co-author numerous publications such as Technical Handbooks, White paper, Tutorials, Users Guides, and FAQs. Refer to manuals here. Theo also holds a degree in Computer Science, Business Administration and various certifications in information security and technologies. He considers himself a technophile since his engagement at Cable & Wireless then later known SLET.

https://yame.space/
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