The nation’s major health insurers are promising to scale back and improve a widely despised practice that leads to care delays and complications.
UnitedHealthcare, CVS Health's Aetna and dozens of other insurers say they plan to reduce the scope of health care claims subject to prior authorization, standardize parts of the process and expand responses done in real time.
Prior authorization means insurers require approval before they’ll cover medical care, a prescription or a service like an imaging exam. Insurers say they do this to guard against care overuse and to make sure patients get the right treatment.
But doctors say the practice has grown in scope and complication, leading to frequent care delays. The fatal shooting of UnitedHealthcare CEO Brian Thompson in December prompted many people to vent their frustrations with coverage issues like prior authorization.
Major health insurers have promised to overhaul the paperwork-laden process before, but little has changed.
Dr. Mehmet Oz, who now oversees the Centers for Medicare and Medicaid Services, said on Monday that insurers are motivated to make something stick this time around.
“There's violence in the streets over this,” Oz said during a news conference Monday, hours after meeting with most major U.S. insurers. “Americans are upset about it.”
Insurers said Monday that they will standardize electronic prior authorization by the end of next year to help speed up the process. They will reduce the scope of claims subject to medical prior authorization, and they will honor the preapprovals of a previous insurer for a window of time after someone switches plans.
They also plan to expand the number of real-time responses, and they say they will ensure that claims denied for clinical reasons will continue to get reviews by “medical professionals.” But they made no promises that those reviewers will be in the same specialty as the treating doctor, a common complaint from physicians.
Insurers have promised to voluntarily make the changes, but Oz said that the Trump administration will look into regulations if progress isn't made.
"You fix it or we’re going to fix it," Oz said.
Researchers say prior authorization has grown more common as care costs have climbed, especially for prescription drugs, lab testing, physical therapy and imaging exams.
“We’re sort of trapped between care being unaffordable and then these nonfinancial barriers and administrative burdens growing worse,” said Michael Anne Kyle, an assistant professor at the University of Pennsylvania who studies how patients access care.
Nearly all customers of Medicare Advantage plans, the privately run version of the federal government's Medicare program, need prior authorization for some services, particularly expensive care like hospital stays, the health policy research organization KFF found in a study of 2023 claims. The study also found that insurers denied about 6% of all requests.
Dr. Ashley Sumrall of Charlotte, North Carolina, says she has seen an increase in prior authorizations required for routine exams like MRIs. An oncologist who treats brain tumors, Sumrall said these images are critical for doctors to determine whether a treatment is working and to plan next steps.
Doctors say delays from requests that are eventually approved or coverage rejections can harm patients by giving a disease time to progress untreated. They also can spike anxiety in patients who want to know whether their tumor has stopped growing and if insurance will cover the scan.
“There’s a term that we use called ‘scanxiety,’ and it’s very real,” said Sumrall, a member of the Association for Clinical Oncology’s volunteer leadership.
Different forms and varied prior authorization policies also complicate the process. Sumrall noted that every insurer “has their own way of doing business.”
“For years, the companies have been unwilling to compromise, so I think any step in the direction of standardization is encouraging,” she said.
The insurers say their promises will apply to coverage through work or the individual market as well as Medicare Advantage plans and the state and federally funded Medicaid program.
Murphy reported from Indianapolis. Seitz reported from Washington, D.C.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
FILE - A Medicare Advantage PPO card rests on top of a Medicare card in Portland, Ore., June 10, 2024. (AP Photo/Jenny Kane, File)
ADELAIDE, Australia (AP) — Nathan Lyon dented England's desperate Ashes survival bid with three quick blows: vice-captain Harry Brook, bowled; captain Ben Stokes, bowled; leading scorer Zak Crawley, stumped.
Just as England was starting to gain confidence Saturday chasing what needed to be a world-record 435 to keep the Ashes series alive, Lyon returned to the Australian attack.
Crawley (85) and Brook (30) had combined in a 68-run stand to revive England's innings from 109-3 to 177-3 after Australia skipper Pat Cummins took out the top order.
Then Lyon, who moved to No. 2 on Australia's all-time list of wicket-takers with two dismissals in the first innings, started a new spell in the evening session.
Lyon dismissed a cavalier Brook, who reached too far and completely missed an attempted reverse sweep, with his second ball. The 38-year-old spinner quickly took three wickets for eight runs in a sequence that ripped through the middle order and suddenly England was 194-6.
Its totemic skipper, Ben Stokes, was out trying to defend against Lyon but missing a turning ball that rattled his off stump. Crawley, playing patiently in pursuit of a sixth test century, was deceived by a drifting Lyon delivery and stumped by Alex Carey.
At stumps on Day 4, England was 207-6 and needing 228 runs for an improbable victory in the third test.
Australia, which hasn't lost an Ashes test at home since 2010-11, needed four wickets to clinch the five-match series with two tests to spare.
After losing the first two tests in Perth and Brisbane, England needs a victory to have any hope of reclaiming the Ashes. Australia needs only a draw to retain the Ashes.
“We’ll reflect on today and make plans for tomorrow,” Australia wicketkeeper Alex Carey said in a post-match TV interview, trying to play down his team's strong position.
Of Lyon's impact, Carey added: “He toiled away all day, finally got some reward.”
Cummins rattled the top order in three quick spells, dismissing Ben Duckett (4) and Ollie Pope (17), both caught by Marnus Labuschagne, on either side of the lunch interval. Then he returned to have Joe Root, the No. 1-ranked batter in test cricket, caught behind for 39.
It was the 13th time in Cummins has dismissed the former England captain in test cricket. And it was an all-too familiar setup, Cummins putting the ball on a consistent length before getting Root to dabble at a ball that shaped in and then seamed away.
It was an important contribution for the Australian skipper after he missed the first two tests through injury.
Even his Australian teammates late in the afternoon were mildly taunting Lyon, who said in a TV interview earlier this month he was “filthy” at being dropped from the lineup for the second test in Brisbane. Chirps of “C'mon Big Fil. C'mon Filthy” echoed from fielders around the stumps in encouragement for the veteran spin bowler after his three-wicket burst.
Lyon hadn't taken a wicket in 27 overs and had figures of 0-50 from 10.1 overs in the second innings Saturday before he completely swung the momentum in Australia's favor.
Even part-timer Travis Head had caused trouble for the England batters while Lyon was out of the attack, before Australia's frontline spinner seized back control.
For much of Day 4, England was playing the better cricket.
Australia resumed at 271-4 in its second innings, a lead of 356, with Head unbeaten on 142 and Carey on 52.
Head’s dismissal for 170 triggered a lower-order collapse, with the last six wickets falling for 38 in 11 overs. The Australians were all out for 349, a lead of 434.
Head's 162-run stand with Carey ended when he pulled a short ball from Josh Tongue (4-70) high and deep into the outfield.
Stokes then had Carey out for 72, tucking a short ball around the corner and caught at leg slip in a smart piece of field positioning.
Brydon Carse (3-80) dismissed Cummins (6) and Lyon on consecutive balls but Scott Boland left a wide ball to deny England its first Ashes hat-trick since 1999.
The highest successful fourth-innings run chase was West Indies’ 418 in a three-wicket win over Australia at Antigua in 2003.
England has successfully chased 370-plus targets twice to win against India in the last three years.
AP cricket: https://apnews.com/hub/cricket
Australian players celebrate after England's Ben Stokes, right, was dismissed during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England's Zak Crawley reacts after he was out stumped by Australia's Alex Carey, left, during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
Australia's Nathan Lyon, second left, is congratulated by teammates after dismissing England's Ben Stokes during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
Australian players celebrate after England's Ben Stokes, right, was dismissed during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
Australia's Nathan Lyon, second left, is congratulated by teammates after dismissing England's Ben Stokes during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
Australia's Pat Cummins, centre, celebrates with teammate Australia's Marnus Labuschagne, right, after dismissing England's Ollie Pope during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England batsmen Zak Crawley, right, and Joe Root gesture during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England's Joe Root bats during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England's Ben Stokes, right, walks with teammate Jofra Archer after dismissing Australia during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
Australia's Pat Cummins is congratulated by teammates after dismissing England's Ben Duckettduring play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England's Ben Stokes, right, celebrates after dismissing Australia's Alex Carey, left, during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England's Ben Duckett walks from the field after he was dismissed during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England's Jofra Archer bowls during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
England's Ben Stokes, centre, celebrates with teammates after dismissing Australia's Alex Carey during play on day four of the third Ashes cricket test between England and Australia in Adelaide, Australia, Saturday, Dec. 20, 2025. (AP Photo/James Elsby)
