Physicians Highlight Administrative Burdens of Prior Authorization 

By Consumers for Quality Care, on July 10, 2024

Physicians Highlight Administrative Burdens of Prior Authorization 

A new survey from the American Medical Association (AMA) shows how prior authorization processes create hurdles for consumers attempting to access health care, according to Rev Cycle Intelligence

The survey found that over a quarter of prior-authorization requests are denied. Though in theory prior authorization is meant to lower health care costs by deterring doctors from ordering unnecessary tests and procedures, the reality is that the process often prevents consumers from accessing the medical care they need. 

According to the survey, 94 percent of physicians say patients face delays in care when insurance companies require prior authorization. Nearly four out of five physicians report that treatment is abandoned when insurance companies deny coverage, hurting health care outcomes for consumers.  

Also concerning is the fact that prior authorization creates an administrative burden for physicians. On average, physicians complete 43 prior authorization forms each week, amounting to 12 hours of work per week. Clinics that can afford extra administrative staff will at times have employees exclusively dedicated to prior-authorization administrative work. 

Additionally, 73 percent of physicians agreed that prior authorization requirements have “somewhat or significantly increased” since 2019, even as the number of physicians appealing these denials has decreased. Physicians cite previous denials, the fact that patient care cannot be delayed, the need to move on to other forms of treatment, and the lack of staff to file appeals as the major reasons for why they don’t oppose these denials.  

According to AMA President Bruce A. Scott, MD, “The time is now for Congress to adopt reintroduced prior authorization reform legislation that prioritizes patients’ access to care, reduces administrative burdens on physicians, and preserves resources for high-quality care.”  

CQC urges both lawmakers and insurers to eliminate needless, burdensome processes that prevent consumers from receiving the medical care they need.