Physical therapists and patients may face plenty of challenges when it comes to dealing with private insurers, but for those who participate in the Humana system, preauthorization for physical therapy is no longer one of them. In a move strongly supported by APTA, the insurer lifted the prior authorization requirement for outpatient physical therapy, occupational therapy, and speech-language pathology.

Humana made the announcement earlier this month, stating that the change was effective December 18, and applies to both commercial and Medicare Advantage policies. Other elements of the Humana benefit package remain unchanged, including visit limits, referral requirements for some plans, and medical necessity requirements. Prior to the change, PTs, occupational therapists, and speech-language pathologists were required to obtain preapproval from a utilization management/review vendor.

APTA has long advocated for the elimination of prior approval as a much-needed change for patients and providers, but also as a way for the association and the insurer to demonstrate how more collaborative relationships can improve the health care landscape.

"This is great news for patients and PTs," said Elise Latawiec, PT, MPH, APTA senior practice management specialist. "But this change also presents an even bigger opportunity. When we demonstrate how the elimination of prior authorization can reduce administrative burdens on PTs, decrease overall costs, and improve outcomes in the Humana system, we build an even stronger case that we can make to other insurers with prior authorization requirements. As a profession, we are committed to being responsible stewards of limited health care resources, and can show that we can be held accountable without the use of an intermediary gatekeeper."

Providers working with Humana can get more detailed information on the change by contacting the Humana telephone number listed on a patient's member identification card.

The Humana decision represents a reversal in a trend toward greater use of utilization management (UM) vendors among insurers. APTA works to keep its members informed on the UM environment through an online toolkit that debuted in 2017. The association is also bringing the profession's voice to the table by participating in various payer and utilization management advisory groups.