Prior Authorization Delays Cause Patients Avoidable Stress

Imagine this scenario: you go to your doctor with a problem. You explain your symptoms, your doctor listens, makes a diagnosis, and together you come up with a treatment plan that works for you. All seems well, until your doctor realizes there’s a problem. Your treatment is going to be delayed, not because of any health-related reason, but because your insurance company will not allow your treatment to proceed without prior authorization. 

When a treatment or prescription requires prior authorization, it means that the insurance company must approve the course of care before it can be administered. Note that insurance representatives are not medical professionals. And they are not there to represent the patient’s best interests. Their one and only goal to save their company money.

This creates a system where doctors are forced to justify their medical decisions to people who may not know the first thing about medicine. It is a waste of time and energy that should be going towards patients. Worse, these unnecessary hurdles come with dire consequences for both medical professionals and patients. 

According to the American Medical Association’s 2025 Advocacy Report, 24% of doctors report that prior authorization has caused a serious adverse event for a patient (meaning a patient was hospitalized, permanently harmed, or died). 78% reported patients abandoning care plans due to prior authorization, and 95% believed that prior authorization somewhat or significantly contributed to physician burnout.

Remember, prior auth is a cost saving measure. People’s health and lives are being traded for profits.

It makes sense why prior auth causes so many poor outcomes. On the patient side, being sick is already exhausting and overwhelming. There numerous barriers to accessing care, so when yet another wall appears, it can feel insurmountable. It may even be insurmountable. Without insurance, most people cannot simply pay for medical care out of pocket thanks to runaway costs. Abandoning care is not always a choice, but something forced on people.

For doctors, they are forced to take on hours of administrative work just to get their patients treatment. To add insult to injury, prior auth processes are often unclear and archaic. Some insurance companies require phone calls, long hold times, and even faxes as their only means of communication. It is needlessly inefficient, and it forces doctors to spend hours on the phone when they could be doing the job they trained for. Now doctors are even afraid that insurance companies are using AI to determine prior authorization. If arguing with a layperson is bad, imagine trying to plead one’s case to a computer.

There is absolutely no medical reason for prior authorization to exist. Its only purpose is to place insurance company savings over patient’s lives. Which is why the AMA has made it a major point of their advocacy to reform the practice, including through policy and legislation.

Recent years have seen some victories. The Center for Medicare and Medicaid services adopted new rules for prior authorization, including requirements for electronic PA requests (rather than phone calls or faxes); stricter timelines for decisions; and requirements that insurers provide specific reasons for any denial, which facilitates an easier appeals process. These changes are estimated to save doctors $15 billion over ten years by streamlining patient care. Nine states have also passed bills for prior auth reforms based on AMA recommendations. 

These changes cannot come soon enough. Prior auth delays can leave patients without necessary medications, like insulin. They can cause people to use up FMLA while awaiting treatment, risking their livelihoods. And in an environment where physicians are experiencing high rates of burnout already, we cannot afford to make their jobs even more difficult. Prior authorization is a practice that must be reformed. It easily can be. People’s lives depend on it.