Major policy shift aims to simplify outpatient approvals
Humana Inc. announced plans to eliminate approximately one-third of prior authorization requirements for outpatient services by January 1, 2026, marking a significant step toward reducing administrative burdens in healthcare.
The changes will include removing authorization for diagnostic services such as colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs. The move is part of a broader industry trend aimed at addressing growing frustrations among patients and providers over the complexity and delays caused by prior authorization processes.
“Today’s healthcare system is too complex, frustrating, and difficult to navigate, and we must do better,” said Jim Rechtin, CEO of Humana, a US-based health insurance firm.
Health insurers, including Humana and competitors like UnitedHealth Group, have come under increasing scrutiny for cumbersome approval systems that can delay or deny necessary care.
While insurers maintain that these protocols help manage care quality and costs, critics argue that the red tape contributes to unnecessary suffering and care delays.
Humana also announced it will begin publicly reporting prior authorization metrics in 2026, including the number of requests approved, denied, appealed, and overturned, along with average turnaround times.
By that year, Humana also pledges to deliver decisions within one business day for at least 95% of complete electronic prior authorization requests. Currently, the company meets that target for more than 85% of outpatient procedures.
The move follows UnitedHealth’s March announcement to cut 25% of reauthorization requirements for prescription renewals across 80 medications. Meanwhile, industry group AHIP has committed to standardizing electronic prior authorization requirements by January 2027.
Humana’s changes signal ongoing efforts across the healthcare sector to modernize outdated approval systems and improve the patient experience through more efficient processes and greater transparency.
