Op-Ed: Insurance Red Tape Is Delaying Care for Millions of Americans
By Sally C. Pipes
Few things frustrate patients more than the insurance paperwork that stands between them and the care they need. A new poll from KFF shows just how serious the problem has become.
Nearly seven in ten Americans say insurer prior authorization requirements are a “burden.” More than one-third call them the biggest challenge they face navigating the healthcare system.
Prior authorization requires doctors and patients to obtain approval from insurers before certain treatments, medications, or procedures can be covered. In theory, the process helps insurers prevent unnecessary care and control costs. In practice, it often delays treatment and forces physicians to wade through waves of paperwork.
According to the KFF survey, nearly half of insured adults say their care has been denied, delayed, or altered in the past two years because of insurance requirements. One in four say those delays harmed their physical health.
Doctors face a heavy burden as well. A 2024 survey from the American Medical Association found that physicians and their staff spend an average of 12 hours each week dealing with prior authorization requests.
Even more troubling is that much of this administrative effort serves little practical purpose. In Medicare Advantage, more than 90% of prior authorization requests are ultimately approved. When requests are denied, over 80% of those denials are overturned on appeal.
In other words, patients and doctors are often forced to navigate a time-consuming approval process for treatment insurers end up approving anyway.
A more sensible approach would narrow prior authorization requirements to the treatments that truly warrant scrutiny while standardizing the process across insurers. Many approvals could be automated or delivered in real time through electronic systems. Urgent or time-sensitive care should be exempted whenever possible.
Consider cancer care. As Paragon Health Institute researcher Jackson Hammond noted in a recent paper, prior authorization rules frequently lead to delays in treatment for cancer patients. In one survey, 96% of oncologists said prior authorization had harmed patients by delaying necessary care.
Yet insurers ultimately approve roughly 90% of cancer treatment requests.
When patients with life-threatening illnesses must wait for approval for care that insurers almost always authorize anyway, something is clearly broken.
There are encouraging signs that change may be coming. In a recent agreement with the Trump administration, many of the nation’s largest insurers pledged to streamline prior authorization requirements. They’ve agreed to reduce the number of services subject to prior authorization, increase transparency in decision-making, and ensure that 80% of electronically submitted requests receive real-time responses.
Congress could also consider requiring insurers to publish clear lists of treatments subject to prior authorization — and to regularly review those lists. If a service is approved more than 90% of the time, it should automatically be removed from prior authorization requirements.
Patients shouldn’t have to fight through layers of insurance paperwork to receive treatments insurers approve anyway.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes. This piece was originally published by PennLive.
