Patient and Consumer Protections

New & Noteworthy
Prior Authorization
  • The Health Wonk Shop: Prior Authorization in Health Insurance

        Nearly 1 in 5 consumers with health insurance say their insurer delayed or denied care in the past year due to its requirements for prior authorization, a process through which insurers can require patients to obtain approval in advance before they will agree to cover specific services. Insurers point to prior authorization asMore

  • Consumer Problems with Prior Authorization: Evidence from KFF Survey

    This Data Note highlights findings from the KFF Consumer Survey on problems consumers have experienced with prior authorization requirements. Overall, those with Medicaid, those who are higher utilizers of care, and those who seek certain types of care such as care for a mental health condition or diabetes encountered more problems with prior authorization over the past year.

  • Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021

    We analyze data from CMS to examine the number and outcome of Medicare Advantage prior authorization requests in 2021, overall and by firm.

  • CMS Prior Authorization Proposal Aims to Streamline the Process and Improve Transparency

    This brief explains a new proposed federal regulation aimed at reducing administrative hassles involved in obtaining prior authorization for care and sets out key policy questions, including how the proposal could impact the patient experience and data privacy.

  • KFF Health News: States Target Health Insurers’ ‘Prior Authorization’ Red Tape

    Doctors, patients, and hospitals have railed for years about the prior authorization processes that health insurers use. The Biden administration announced a crackdown in January, but some state lawmakers are looking to go further.

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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.