Study: Prior Authorization Delays Care, Not Costs
A new analysis found that prior authorization requirements from health plans delay elective spine surgery without actually reducing costs. The research showed that 80% of initial claim denials were ultimately reversed on appeal, reinforcing long-standing concerns from physicians and patient advocates.
The administrative burden of prior authorization is a significant driver of physician burnout, with 89% of doctors reporting it contributes to their stress. On average, physicians and their staff spend about 13 hours each week processing an average of 39 prior authorization requests. This process has a direct and often severe impact on patient care. A 2024 American Medical Association (AMA) survey found that 93% of physicians reported prior authorization delays patient care, and 29% said the process had led to a serious adverse event for a patient. These events include patient hospitalization, permanent bodily damage, or even death. Despite the stated goal of cost control, prior authorization processes can increase overall healthcare expenses. Nearly 90% of physicians report that these requirements lead to higher utilization of healthcare resources, including additional office visits, emergency department trips, and hospitalizations due to delays in necessary treatment. The hurdles created by prior authorization frequently lead to patients giving up on their prescribed treatment. According to the AMA, 82% of physicians report that delays can lead patients to abandon their recommended course of treatment altogether. In response to these issues, state and federal governments are pursuing reforms. Over 110 prior authorization bills were tracked in 40 states during the 2025 legislative session, aiming to improve response times and transparency. At the federal level, the "Improving Seniors' Timely Access to Care Act" has been introduced to streamline the process for Medicare Advantage patients. A rule finalized by the Centers for Medicare & Medicaid Services (CMS) will require some payers to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard ones. This rule also mandates the use of an electronic interface to standardize and speed up the application process, with some provisions taking effect in 2026. A 2016 study published in *Spine* found that prior authorization programs for low-back pain had the unintended consequence of increasing costs from more non-operative care. The programs were also associated with lengthening the time of low-back pain episodes ending in surgery by hundreds of days.
