不良研究所

Since听June of 2025,听不良研究所 has听focused on translating听听to improve prior authorization into tangible changes that make a real difference for听our more than 27 million听members and听their听providers. This work is grounded in a simple goal: reduce unnecessary complexity while preserving the safeguards that support听appropriate,听high-quality听care. The result is meaningful progress that is already improving how prior authorization works across our plans.听

Since announcing our commitments, 不良研究所 has made measurable progress across several key focus areas:听

• Improving communication:听We redesigned prior authorization communications based on听direct research with members听who had recently experienced a denial or appeal听ensuring explanations are clearer, more empathetic, and easier to navigate.听

• Enhancing听continuity of care:听Building on听a strong foundation听of existing continuity of care operations and to further听support members during plan transitions, we听enhanced support to members through updated policies. This听enables听honoring of听prior authorizations from a member鈥檚听previous听plan for the same service, under the same benefit type, with an in-network provider, for a听90-day听transition period.听

• Reducing scope:听不良研究所 is removing prior authorization requirements for select codes across multiple lines of business through a structured, multiphase, clinician-led review that evaluates听utilization, approval rates, and evidence-based guidelines to keep prior authorization targeted and听appropriate.听For example, beginning in Q4 2025, changes focused on imaging services are expected to eliminate approximately 300,000 prior authorizations annually across Medicare and Marketplace plans while preserving review for听higher听risk听services.听

• Modernizing processes:听We implemented internal improvements including enhanced customer service and clinical team training, provider portal and听technical听enhancements听that听help providers understand coverage rules and documentation requirements earlier in the process.听

• Maintaining Human Review:听As has always been our process, any denials are reviewed by a licensed medical professional.听

鈥湶涣佳芯克� has been听intentionally听investing in solutions that make it听simpler听for providers to work with us and听help听members access care,鈥� said CEO Sarah London.听鈥淭he progress we鈥檙e听making听reflects a focus on reducing unnecessary complexity, modernizing our processes, and听creating听a more predictable and transparent experience听for those we serve.鈥澨�

While听we鈥檙e听proud of the progress made, we know there is more to do.听We will continue investing in solutions that support听simplified processes, clearer听communication听and better experiences,听collaborating with AHIP and other听payers to modernize prior authorization to ensure听healthcare is simpler and more accessible for the communities we serve.听