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Humana will make a sweeping reduction in prior authorization, often called “preapproval,” requirements for outpatient services, the Fortune 100 company announced on July 22, 2025. One of the nation’s largest health insurers, Humana will eliminate approximately one-third of these mandates by January 1, 2026, aiming to expedite care, cut red tape for healthcare providers, and improve experiences for patients.
The insurer also said it is “committing to greater transparency on prior authorization” as the insurance industry faces mounting pressure to reform the controversial pre-approval protocols that have long frustrated patients and providers alike. Humana’s decision is poised to influence industrywide standards, having ripple effects for the broader U.S. healthcare system.
What are prior authorization mandates?
Prior authorization is a process health insurers use to determine whether they will cover a prescription, medical procedure, or service. Providers must seek approval from insurers before delivering certain treatments, a process meant to control costs and prevent unnecessary or potentially harmful interventions.
While intended as a safeguard, prior authorization has often been criticized for causing delays, increasing administrative workload for physicians, and potentially leading to patient care interruptions.
As Humana slashes roughly one-third of its prior authorization requirements for outpatient services, the cuts will specifically target frequent diagnostic services, including colonoscopies, transthoracic echocardiograms, and certain CT and MRIs. By next January, Humana pledges to deliver decisions within one business day for at least 95% of all fully completed electronic prior authorization requests. Humana said that rate is currently just above 85% for outpatient procedures.
Also in 2026, the company will introduce a national gold-card program, under which healthcare providers with a proven record of submitting medically sound and appropriate requests will be exempt from some pre-approval requirements altogether, encouraging high-quality care.
Humana also committed to reporting, starting in 2026, on how many prior authorization requests are approved, denied, or reversed on appeal, as well as what the average decision time is. This step aligns with new federal requirements and growing demands for public accountability.
Why this move matters
Patients stand to receive essential services faster. Delays, denials, and the administrative maze associated with prior authorization have historically led to missed treatments, poorer outcomes, and mounting frustration.
With prior approvals eliminated for many routine tests and scans, out-of-pocket spending may drop for those whose delayed approvals could have resulted in more severe, costlier interventions down the road.
Doctors and their staff spend significant time and resources navigating insurance paperwork, so should be freed up to focus more on patient care rather than bureaucracy. The gold card program is designed with better incentives in mind: to reward providers who consistently deliver high-quality, appropriate care.
Humana’s move follows actions by other major insurers to reduce prior authorization requirements, responding to public and legislative scrutiny. In June 2025, a coalition of insurers—under the guidance of trade groups and federal leaders—announced new pledges to overhaul prior authorization standards, accelerate decisions, and enhance transparency for both patients and providers.
The federal government and several state legislatures have begun crafting bills to regulate how and when insurers can require prior authorization, citing patient safety and market fairness.
Humana did not immediately respond to a request for comment.
For this story, Fortune used generative AI to help with an initial draft. An editor verified the accuracy of the information before publishing.
This story was originally featured on Fortune.com
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