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New Federal Rule Speeds Up Health Insurance Decisions on Medical Care

Set to take effect in 2026, the rule requires insurers to respond to urgent requests within 72 hours and non-urgent requests within a week, potentially saving healthcare providers over $15 billion in a decade.

This Nov. 8, 2018 file photo shows a page from the 2019 U.S. Medicare Handbook in Washington. (AP Photo/Pablo Martinez Monsivais, File)
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Overview

  • New federal rule announced by the Biden administration requires health insurers to respond to requests for urgent medical services within 72 hours, and non-urgent requests within one week.
  • The rule, set to take effect in 2026, applies to private Medicare, Medicaid and Affordable Care Act health insurance plans, but not to employer-offered plans or veterans receiving care through the Department of Veterans Affairs.
  • Insurers will be required to provide a specific reason for denying a request for care and to publicly report figures on prior authorizations.
  • Health insurers will need to develop computer systems by 2027 to allow doctors to view historical claims and other data.
  • The rule is expected to save doctor practices and hospitals more than $15 billion in 10 years due to increased efficiencies.