Blue Cross Blue Shield of Michigan will eliminate 20% of prior authorization requirements, joining big players such as UnitedHealth Group and Cigna in responding to complaints about what providers characterize as an increasing burden, the company announced Thursday.
The nonprofit health insurer will end precertification requirements for procedures such as bariatric surgery, breast biopsy, cardiac rehab services and more for its Medicare and commercial enrollees, Chief Medical Officer Dr. James Grant said. Blue Cross Blue Shield of Michigan also will expand its “gold card” program that eases prior authorization requirements for physicians with high approval rates, the company said in a news release. According to the Blues carrier, 2.9% of the 87 million claims it processes each year are subject to prior authorization.
“We’re doing this on our own. We are doing this because it’s the right thing to do,” Grant said. “This is not part of a one-time solution. This is going to be a continual process. We’re going to continually look at the effectiveness and do everything we can to make sure that our members are getting the right care at the right time.”
The health insurance company holds a 68% commercial plan market share in Michigan, which the American Medical Association deems the second-least-competitive insurance market in the U.S.
A growing number of insurers are rethinking prior authorizations amid complaints from providers, patients and policymakers, including UnitedHealth Group, Cigna and other Blue Cross and Blue Shield companies.
Blue Cross Blue Shield of Michigan was working on revisions to its prior authorization requirements before those other companies announced changes to theirs, Grant said. “It’s purely coincidence,” he said. “Once these things also started coming out, one of the things that we’ve noticed—and that’s why we wanted to be even more aggressive—is a lot of the plans were eliminating procedures that we never required prior authorization for.”