Prior auth is being priced as labor
Physicians and groups are pushing the idea that prior authorization is not just an annoyance but paid labour that should be reimbursed, reframing the activity as a measurable cost. This argument highlights that chasing approvals consumes skilled staff time and creates a clear economic frame for automation or workflow change. (medicaleconomics.com)
A doctor can treat a patient in 15 minutes and then spend the next 30 arguing with an insurer about whether the treatment is allowed. That is why physicians are starting to describe prior authorization as labor with a price tag, not just paperwork. (medicaleconomics.com) Prior authorization means a health plan wants advance approval before it will pay for a drug, scan, or procedure. The American Medical Association says 1,000 physicians in its 2024 survey still reported that the process delays care, worsens outcomes, and adds unnecessary spending. (ama-assn.org) That survey found the average physician handles 39 prior authorization requests a week. It also found physicians and staff spend 13 hours a week on them, which is almost one-third of a full-time employee before a single claim is paid. (ama-assn.org) Medical Group Management Association data puts the staffing effect in even plainer terms. In its 2024 issue brief, 92% of medical practices said they had hired or reassigned staff because prior authorization requests increased. (mgma.com) Once you frame the work as labor, the next argument is obvious: labor usually gets billed. The American Academy of Family Physicians reported that a proposed time-based Current Procedural Terminology billing code for prior authorization work reached the American Medical Association panel agenda in May 2024 before being withdrawn for revision. (aafp.org) The point of that code was not symbolic. Family Physicians journal said the logic was to force insurers to face the cost they create, because every extra form, portal login, and appeal uses physician or staff time that a practice has to pay for. (aafp.org) Doctors are also pushing this argument because the patient damage is easy to count. In the American Medical Association survey, 93% of physicians said prior authorization delays necessary care, 82% said it can lead patients to abandon treatment, and 29% said it has led to a serious adverse event for a patient in their care. (ama-assn.org) Washington has mostly tried to fix the process instead of paying for the work. The Centers for Medicare and Medicaid Services finalized a rule on January 17, 2024 that pushes certain insurers toward electronic prior authorization, requires specific denial reasons, and sets implementation dates that run mainly into January 1, 2027 for the application programming interface pieces. (cms.gov) Insurers have started making voluntary cuts too, but those cuts are partial. AHIP said in June 2025 that major plans would streamline and reduce prior authorization, and UnitedHealthcare said in July 2025 that it had already reduced its prior authorization volume by nearly 20% in 2023 and was targeting another 10% reduction in 2025. (ahip.org) (uhc.com) That still leaves the core fight unchanged. If prior authorization is treated as a free administrative chore, insurers can keep offloading the cost onto clinics, but if it is treated as paid labor, every approval request starts to look like an invoice someone else should have to cover. (medicaleconomics.com)
