One year after the Trump administration announced that dozens of health insurers had signed a six-part pledge<\/a> promising to reduce barriers to doctor-recommended care, some insurers now say they won\u2019t implement all the promised initiatives.<\/p>\n Meanwhile, patients, their advocates, and clinicians say little has improved.<\/p>\n \u201cIt has never been this bad for patients,\u201d said U.S. Rep. Greg Murphy (R-N.C.), a physician who co-chairs the GOP Doctors Caucus.<\/p>\n The overarching intent of the June 2025 pledge was to improve a controversial process called prior authorization, which regularly requires patients or someone on their medical team to seek approval from insurers before proceeding with treatment.<\/p>\n According to AHIP, the health insurance industry trade group, health plans have eliminated 6.5 million prior authorizations for patients \u2014 equal to an 11% reduction \u2014 since the announcement.<\/p>\n But critics remain skeptical. Sally Nix, a patient advocate<\/a> who has a chronic disease, described the voluntary pledge as \u201cperformative.\u201d And Murphy, who participated in the news conference with Health and Human Services Secretary Robert F. Kennedy Jr. announcing the pledge last year, said it has \u201cno teeth.\u201d<\/p>\n Voluntary insurer pledges rarely make things better for patients, said Sabrina Corlette<\/a>, a research professor at the Center on Health Insurance Reforms at Georgetown University.<\/p>\n \u201cIn the absence of clear rules, policies, standards, and mandates,\u201d she said, insurance companies are \u201cgoing to do what makes sense for them to do financially.\u201d<\/p>\n The Department of Health and Human Services did not respond to questions for this report. It isn\u2019t clear how, or whether, the Trump administration is holding insurers accountable.<\/p>\n \u2018Zero Faith\u2019<\/strong><\/p>\n Prior authorization \u2014 sometimes called preauthorization or precertification \u2014 has been around for decades. The insurance industry has long argued that the practice, which varies by company, helps control costs, reduces waste and fraud, and prevents potential harm to patients. It\u2019s regularly invoked for a huge swath of services, ranging from low-cost urgent care<\/a> to expensive cancer treatment<\/a>.<\/p>\n \u201cPrior authorization is a vital patient safeguard,\u201d said Chris Bond, a spokesperson for AHIP.<\/p>\n The 2024 killing of UnitedHealthcare CEO Brian Thompson<\/a> sparked a national groundswell of anger about insurance denials, with patients and doctors becoming increasingly vocal<\/a> about the tactics they say insurance companies use to boost profits at the expense of care.<\/p>\n Prior authorization reform is one of the rare healthcare issues Democrats and Republicans tend to agree on. On July 15, the House Ways and Means Committee unanimously advanced a bill<\/a> that would force Medicare Advantage plans to provide to the federal government a list of all items and services that are subject to prior authorization, and to report data about denials and grievances, among other requirements.<\/p>\n Last year\u2019s industry pledge was organized as a direct response to public anger, Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said when it was announced. \u201cThere\u2019s violence in the streets over these issues,\u201d he said.<\/p>\n \u201cAmericans are upset about it,\u201d Oz said, later adding, \u201cI\u2019m looking forward to seeing the results.\u201d<\/p>\n Mike Gartner, founder of Health Access Innovation, an organization that helps patients overturn insurance denials, said he doubts that insurance companies are changing their policies in meaningful ways. The 11% reduction in prior authorization cited by AHIP \u201chides a lot of nuance,\u201d Gartner said.<\/p>\n Patients who need the costliest services, such as cancer treatment, are still being disproportionately denied access to doctor-recommended care, he said.<\/p>\n AHIP said its data included reductions in prior authorization for medical services, not prescription medicines. The trade group didn\u2019t provide details explaining which services have been dropped from prior authorization or how those reductions differ across individual insurers.<\/p>\n Last year, Oz said the federal government would be \u201cevaluating progress\u201d toward the pledge and \u201cdriving accountability,\u201d and he foreshadowed \u201cpublic dashboards.\u201d But no such dashboards exist, and federal officials did not respond to questions about how they\u2019re holding companies accountable.<\/p>\n Murphy, the North Carolina congressman, said he has \u201czero faith\u201d in the industry policing itself.<\/p>\n He didn\u2019t believe insurance companies then, he said, \u201cand I don\u2019t believe them now.\u201d<\/p>\n \u2018At War\u2019 With an Insurer<\/strong><\/p>\n In February, days after Betsy Adler and Justin Young\u2019s daughter Coco was born with a serious heart defect, the Stillwater, Minnesota, family received paperwork showing they were racking up out-of-network costs.<\/p>\n During Adler\u2019s pregnancy, the family had switched insurers, moving to Medica<\/a>, a for-profit company based in Minnetonka, Minnesota, and one of many insurers<\/a> that initially signed the industry pledge. Adler said she\u2019d checked with her employer\u2019s human resources department and on Medica\u2019s website to make sure her maternal-fetal specialists and hospital were in-network before their new health plan went into effect earlier this year.<\/p>\n But then, the insurance company started processing some claims as out-of-network. By mid-March, the family had accrued more than $4,000 in out-of-network charges, on top of more than $3,000 for in-network bills. And the bills kept coming.<\/p>\n When Adler, a psychotherapist, called to figure out what was going on, she said, an insurance company representative said she hadn\u2019t submitted a referral from her primary care provider beforehand. Attempts to fix the problem went nowhere. At one point, Adler said, Medica required her to visit a clinic she\u2019d never been to before to obtain a referral. But she said a Medica representative told her the referral was never received, because the insurer\u2019s fax machine was down.<\/p>\n \u201cI have a critically ill child,\u201d Adler remembered thinking shortly after Coco was discharged from the cardiovascular intensive care unit. \u201cI can either spend my emotional energy at war with Medica, or I can let it go and just enjoy my time with my daughter.\u201d<\/p>\n Medica spokesperson Greg Bury said he wouldn\u2019t discuss the case, citing patient privacy rules. In an emailed statement, he wrote the company is \u201ccommitted to working with her to ensure she understands what is covered under her benefits and our responsibilities.\u201d<\/p>\n One of six specific promises all insurers made when they signed the pledge was to honor a 90-day grace period when patients switch insurance plans, starting Jan. 1 of this year. Often called \u201ccontinuity of care,\u201d this grace period allows patients to temporarily continue receiving services and medications that were authorized under a previous insurer.<\/p>\n But that applies only in some circumstances, Georgetown\u2019s Corlette said. The wording of the pledge suggests that insurance companies aren\u2019t obligated to honor another company\u2019s network parameters. When Adler and Young switched insurers, for example, Medica was not obligated to cover the cost of out-of-network providers as if they were in-network, even though they were in-network under the family\u2019s old plan.<\/p>\n Adler and Young switched insurance companies again when Coco was a month old, to avoid accruing more out-of-network costs.<\/p>\n Denial After Approval<\/strong><\/p>\n The percentages cited by AHIP don\u2019t tell the whole story, said Nix, the patient advocate. Insurers are \u201cnot including the data for the loopholes they create,\u201d she said.<\/p>\n For example, nothing in the pledge prevents insurance companies from retroactively denying payment, even when care is preapproved. \u201cPatients are going to see a lot more retroactive denials,\u201d said Nix, who recently had her insurer process, then later deny, a claim for injections to relieve her nerve pain.<\/p>\n Something similar recently happened to Jocelyn Austin, 49, of Amherst, New York. Over the course of nearly 20 years, she developed an addiction to sleeping and anxiety pills prescribed to her by a doctor. Last year, she spent weeks at an inpatient treatment center for substance abuse. Her insurer, Independent Health, had approved the admission. Austin said she has been substance-free since her discharge.<\/p>\n But the facility sent her a bill for more than $12,000 in December showing her insurer had not paid for the treatment she received, according to documents Austin shared with KFF Health News. This was in addition to the $10,000 she paid at the beginning of her treatment to satisfy her out-of-network deductible. The approval letters from Independent Health had specified that \u201cauthorization is not a guarantee of claim payment.\u201d<\/p>\n Frank Sava, a spokesperson for Independent Health, said a denial was issued and upheld in this case because the services provided \u201cwere inconsistent with the care that was authorized\u201d and \u201cthe medical record did not sufficiently support what was billed.\u201d He said those findings were reviewed and confirmed by an outside consultant.<\/p>\n An explanation of benefits issued by the insurer last summer indicated the \u201cprovider,\u201d not the patient, was responsible for the cost of her treatment. And yet the treatment facility has continued to pressure her for payment, she said.<\/p>\n Austin, who has not paid her outstanding bill, said insurance companies \u201cshould be held accountable.\u201d<\/p>\n \u2018Significant Work Ahead\u2019<\/strong><\/p>\n Another one of the six commitments insurers made last year was to adopt new technology that would standardize the electronic submission of prior authorization requests. During the news conference announcing the pledge last summer, Chris Klomp, the director of Medicare and a deputy CMS administrator, said more than 50% of prior authorizations are still paper-based and processed by phone or fax machine.<\/p>\n In April, AHIP released an update<\/a> related to that technology initiative, explaining that participating insurers would adopt the new standards on a rolling basis. Health insurers agreed to implement the pledge\u2019s various commitments by predetermined deadlines, and this initiative is scheduled to be operational by Jan. 1, 2027. But eight insurers that initially signed the pledge last year didn\u2019t sign the technology update when it was announced in April, AHIP told KFF Health News.<\/p>\n Those insurers are Alignment Health Plan, EmblemHealth, HealthFirst, Independent Health, Medica, MVP Health Care, Point32Health, and SummaCare. Their beneficiaries span the country, from California to New York. None of those eight insurers agreed to interviews for this report, but most sent KFF Health News emailed statements indicating that they remain committed to prior authorization reform.<\/p>\n AHIP\u2019s approach to continuity of care \u201cwould have required the transfer of confidential member health information through a non-standardized process involving third-party participation,\u201d wrote Jerry Slowey, a spokesperson for Alignment Health<\/a>, which offers Medicare Advantage policies in Arizona, California, Nevada, North Carolina, and Texas. \u201cWe do not believe that level of data sharing was contemplated in the original commitment.\u201d<\/p>\n Bury, the spokesperson for Medica, which covers beneficiaries in Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, and Wisconsin, said the company \u201csupports the goal of these standardization efforts.\u201d But the April update \u201craised a significant technical and operational hurdle that we are not able to commit to at this time,\u201d he said.<\/p>\n Alex Gomez, a spokesperson for EmblemHealth, said in late June the company \u201cwill sign onto the commitment\u201d after KFF Health News posed questions about why it had not endorsed the April update.<\/p>\n \u201cWe anticipate more plans will be added over the coming months,\u201d said Bond, the AHIP spokesperson. Health plans are \u201cworking continuously to implement their commitments to simplify and improve the experience.\u201d He acknowledged that \u201cthere is still significant work ahead.\u201d<\/p>\n The original pledge also included a promise that insurance companies would enhance transparency and use \u201cclear, easy-to-understand explanations\u201d when communicating to patients \u2014 something they were already supposed to be doing under the Affordable Care Act.<\/p>\n Yet companies still regularly neglect to explain why care has been denied, and their communications often contain \u201cinconsistent and contradictory information,\u201d said Gartner, of Health Access Innovation. He and Murphy also said they suspect insurance companies are increasingly using artificial intelligence to generate denials.<\/p>\n \u201cThey craft the pathways to basically deny things immediately with the hope that people will give up,\u201d Murphy said.<\/p>\n The congressman said he wishes President Donald Trump would sign executive orders addressing some of these issues. \u201cThe problem is the insurance industry is the strongest lobby in this town.\u201d<\/p>\n Do you have an experience with prior authorization you\u2019d like to share?\u00a0Click here<\/a>\u00a0to tell KFF Health News your story.<\/em><\/p>\n<\/div>\n![\"Newsletter](\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\"){kind=icon}
<\/p>\n\n\t\t\t\t\tEmail Sign-Up\t\t\t\t<\/h4>\n
![\"A](\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Insurer-backpedaling-04-rotated.jpg?w=480\")
\n\t\t\t\t\t\t\t\t\t<\/figure>\n<\/p><\/div>\n![\"Betsy](\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Insurer-backpedaling-03.jpg\")
\n\t\t\t\t\t\t\t\t\t<\/figure>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n![\"A](\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Insurer-backpedaling-01.jpg?w=1270\")