Why Prior Authorization Can Be Frustrating
If you’ve ever been told by your doctor that you need a certain treatment or medication, only to find out that your insurance company needs to approve it first, you’ve experienced prior authorization (PA).
The idea behind PA is to ensure treatments are medically necessary and cost-effective, but in practice, the process can be slow, frustrating, and confusing.
According to a study in JAMA Neurology, delays in PA approvals have led to worse health outcomes and increased healthcare costs, as many patients either abandon treatment or face worsening conditions due to delayed care.
A report from ProQuest found that over 80% of physicians believe PA requirements lead to unnecessary delays, creating barriers to timely treatment. This means patients may suffer longer or even end up needing more expensive interventions that could have been avoided if treatment had been approved sooner.
How Delays in Prior Authorization Affect Patients
Research from ScienceDirect highlights how PA-related delays contribute to hospital admissions and emergency visits, particularly among patients with chronic illnesses who require ongoing medications. These delays increase hospitalization rates by nearly 20%, further straining the healthcare system and adding unnecessary costs.
For pediatric patients and those with neurological conditions, the consequences can be even more severe. A study in Health Affairs Scholar found that prolonged PA processes disproportionately impact vulnerable populations, delaying critical interventions that could prevent long-term complications.
How Insurance Companies Can Improve Prior Authorization
To ensure PA works as intended—approving necessary care while preventing unnecessary costs—insurance companies should adopt strategies that make the process more efficient and transparent:
Artificial intelligence (AI) and automation can reduce processing times and minimize manual errors.
A ScienceDirect study found that AI-driven PA systems cut approval wait times by nearly 50%, significantly improving patient access to necessary treatments.
Many chronic conditions, such as diabetes and heart disease, require recurring medications and treatments that should not require repetitive PA approvals.
The ProQuest study suggests that auto-approvals for maintenance medications would prevent unnecessary delays while still allowing oversight for new or high-risk treatments.
Many patients and providers find PA rules complicated and inconsistent, making it hard to navigate the process.
JAMA Neurology recommends clearer communication between insurers, doctors, and patients, including online portals that allow real-time tracking of PA requests.
A major source of frustration for healthcare providers is the lack of consistency in PA rules across different insurers.
Health Affairs Scholar advocates for standardized PA policies, which would reduce administrative burdens and ensure faster approvals for essential treatments.
The Future of Prior Authorization: A Smarter, Patient-Centered Approach
Prior authorization is meant to control healthcare costs and prevent unnecessary treatments, but when approvals take too long, it does more harm than good. By leveraging technology, streamlining approvals, and improving transparency, payers can make PA more efficient—ensuring that patients receive the care they need without unnecessary delays.
References
JAMA Neurology – “The Impact of Prior Authorization Delays on Patient Outcomes”
ProQuest – “Physician Perspectives on Prior Authorization: Barriers and Solutions”
ScienceDirect – “Using AI to Improve Prior Authorization Efficiency”
Health Affairs Scholar – “Reforming Prior Authorization: Policy Recommendations for Payers”
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