Prior Authorization
When Insurance Companies Decide Instead of Doctors
Prior authorization was introduced to control healthcare costs. Now, insurance companies use it as a gate – keeping patients waiting, frustrating doctors, and blocking the care people need most. These practices grant insurance companies – not doctors – the power to make critical decisions about patient care.
DELAYS, RESTRICTIONS, AND DENIALS
Insurance companies wield prior authorization, step therapy, quantity limits, and retroactive denials as tools – turning what should be straightforward care into obstacles. The result:
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Patients wait days or weeks while insurers review or deny authorization, losing precious time for treatment.
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Insurers sometimes approve treatment, then deny it retroactively (NC Health News) – leaving patients with bills they never expected.
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Patients are routed on unnecessary detours. Step therapy forces patients to try less effective treatments before getting the right care.
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Quantity limits block access to the full course of treatment a doctor prescribed.
These practices don’t just frustrate, they lead to serious complications (AMA), worsened conditions, even avoidable suffering. Patients shoulder more risk while hospitals and clinicians waste time battling bureaucracy instead of providing care.
WHY THIS MATTERS TO YOU
When insurers delay or deny care, patients pay the price – with their health, their time, and their savings. Patients are left in limbo, forced to navigate a system designed to limit access rather than provide care, damaging both their physical health and financial well-being. Insurers profit when fewer claims are paid (NAIC). Delays and denials aren’t glitches – they’re part of the business model.
The current system is working against patients when they need help the most.
More than half of voters (67%) believe prior authorization delays necessary care and puts patients at risk (Heal the System Poll). The public can see whose side is in the business of caring – and whose is in the business of profit.
Fix the Broken System
This can’t continue any longer. Lawmakers, healthcare providers, and insurers must work together to remove barriers between patients and their care. It’s time to put patients first and heal the system. The solutions are clear:
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Streamline prior authorizations and approval processes to prevent unnecessary delays in care and administrative burdens.
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End retroactive denials. If treatment is approved, insurers should be held accountable to honor their commitment and cover the costs, reducing financial uncertainty for patients.
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Restore physician authority. Every patient deserves care that is based on a healthcare professional’s assessment of their medical needs, not on a system that prioritizes the bottom line.
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Remove barriers to emergency care. In emergencies, every second counts. Insurance approvals should never stand in the way of urgent medical treatment.
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Stop financial harm to hospitals and providers. Hold insurance companies accountable. Protect care for every community.