From Tom Murphy at the Associated Press, “Top U.S. health insurers vow prior authorization reform.” [Sun-Sentinel, June 24] Quoted from the article, “Insurers said Monday that they will standardize electronic prior authorization by the end of next year to help speed up the process. They will reduce the scope of claims subject to medical prior authorization, and they will honor the preapprovals of a previous insurer for a window of time after someone switches plans.” We will see.

Medical prior authorizations, while intended as a cost-control measure, often prove detrimental to patients, leading to delayed care, worsened health outcomes, and increased administrative burdens (cost) that interfere with the patient-provider relationship. At its core, prior authorization (PA) requires healthcare providers to obtain approval from a patient’s insurance company before delivering certain medications, tests, or treatments. Though insurers argue this process ensures appropriate use of services and prevents unnecessary spending, in practice it frequently results in harmful delays and denials that compromise timely care.

And, with the repositories of “big data” being at insurance companies, surely analysis of that data shows that these changes can be safely and effectively implemented. So, why does it take a year?

One of the immediate negative impacts of prior authorization is treatment delay. According to surveys by the American Medical Association (AMA), a significant number of physicians report that PAs have led to delays in patient care, sometimes exceeding several days or even weeks. [The AMA views prior authorization as an overused, costly, inefficient, and opaque process that often leads to patient care delays and potentially adverse events.] These delays can be critical, especially for patients with chronic or progressive illnesses. For example, in cases involving cancer, heart disease, or mental health conditions, even short delays in initiating treatment can worsen prognosis or lead to complications that might have been preventable with prompt intervention.

Moreover, many prior authorization requirements are not based on the latest clinical guidelines or patient-specific information. This creates a system where insurers second-guess providers’ judgment, despite not having the same level of direct patient insight. In some cases, patients are denied treatments that their physicians consider medically necessary, forcing patients to either forgo care or switch to less effective alternatives. This can have both health and psychological consequences, eroding trust in the healthcare system and leaving patients feeling powerless in decisions about their own care.

The administrative burden of prior authorizations also affects patients indirectly. Physicians and clinical staff must often spend hours navigating complex and inconsistent requirements, diverting time and attention away from direct patient care. This not only contributes to provider burnout but also limits the capacity of clinics—especially those in underserved areas—to efficiently manage high patient volumes. For smaller practices, the resources required to manage PA requests can be prohibitive, further contributing to disparities in access and continuity of care.

Additionally, prior authorizations can disproportionately affect vulnerable populations, such as the elderly, low-income individuals, or those with limited health literacy. These patients may struggle to understand or contest denials, and they may lack the financial flexibility to pay out-of-pocket while appeals are pending. This often leads to treatment abandonment or reliance on emergency services, which are both more costly and less effective than preventive or early-stage care.

In recent years, there has been increasing advocacy from medical societies, patient rights groups, and even bipartisan legislators to reform or streamline the PA process. Proposals include electronic prior authorization systems, standardized forms, and “gold card” programs that exempt high-performing providers from routine reviews. While some insurers have taken steps toward such changes, progress has been uneven and slow.

With elections looming, what we have witnessed is growing unrest by the insured about this antiquated process. After the recent death of UnitedHealthcare CEO Brian Thompson, we saw the frustration manifest and we also saw an election year issue come into focus. Is legislation that is more stringent in the works? [“Dr. Mehmet Oz called the practice “a pox on the system” that hikes administrative costs during his Senate confirmation hearing in March to lead the Centers for Medicare and Medicaid Services.] It is time for the healthcare system to reduce one of its expensive barriers to appropriate care.