A patient anxiously awaits a scheduled surgery, then receives a call the night before at 7:20 p.m. The procedure is postponed because of an unresolved prior authorization issue. The result: delayed care, increased anxiety, and a missed opportunity for timely treatment. This scenario plays out in clinics and hospitals across the country every day.
Prior authorizations (PAs) remain a significant challenge in healthcare, causing delays and frustration for patients, physicians, and staff due to several systemic issues. And, it’s not getting better. Here is a breakdown of why PAs continue to delay care and frustrate everyone involved.
The administrative burden on physicians
According to the American Medical Association’s 2025 Prior Authorization Physician Survey, physicians complete an average of 40 prior authorizations per week, and the process consumes roughly 13 hours of physician and staff time weekly. That is time pulled directly away from patient care. The PA process often requires repetitive submission of documentation, phone calls, and follow-ups, creating unnecessary complexity for both the provider and the payer.
Many facilities and practices lack the dedicated administrative staff to handle PAs, a fast-growing, widespread issue leading to increased stress, delayed treatments, and decreased patient and employee satisfaction. Today, many organizations either absorb the additional workload, creating inefficiencies, or hire more staff to manage the PA process, squeezing margins. Both outcomes directly impact patient satisfaction and operational efficiency.
When delays become dangerous: the real impact of prior authorization
The burden of prior authorization requirements is significant. According to the AMA’s most recent physician survey:
95% of physicians say prior authorization delays access to necessary care.
94% say prior authorization contributes to physician burnout.
79% report that patients abandon treatment altogether due to authorization challenges.
For patients with chronic or serious conditions requiring timely interventions, these delays can be particularly detrimental, underscoring the need for more efficient PA processes.
This issue is further compounded by last-minute cancellations that often occur when prior authorizations are not approved in time. A scheduled procedure can be cancelled the night before or the morning of due to a lack of approved prior authorization, triggering a negative domino effect. Physicians are unable to perform their duties, patients are left distressed, and valuable resources such as procedure rooms and operating rooms sit unused, leading to lost opportunities to treat other patients, and lost revenue.
The chaos of confusion: why lack of standardization hurts prior authorization
Navigating PA requirements should not feel like running an obstacle course, but for most healthcare teams, it does. The absence of standardization across insurance companies and their countless plan variations creates a maze of confusion and inefficiency that drains time, energy, and morale.
Constant rule-changing: each insurer, and often each plan, has its own unique set of PA rules, forms, and documentation requirements. What is required for one patient might be completely different for another, even for the same treatment. This fragmentation forces staff to double-check every detail, every time, just to avoid costly mistakes or denials.
Administrative headaches: the lack of uniformity means staff are caught in a cycle of endless verification, back-and-forth calls, and follow-ups. Instead of focusing on patient care, teams spend hours deciphering insurer-specific protocols and chasing down approvals, leading to frustration and burnout.
Outdated communication: many insurers still rely on fax machines and phone calls, and some do not even offer an online portal to check PA status. This reliance on outdated technology slows the process to a crawl, leaving both patients and providers in limbo while approvals trickle in.
Policy reform moves at a snail’s pace
Despite years of mounting frustration from providers and patients, efforts to reform the PA process remain sluggish. In June 2025, roughly 60 major U.S. health insurers publicly pledged to streamline and simplify prior authorization, with commitments including:
Standardizing electronic submissions across insurers
Reducing the number of services requiring PA
Honoring existing authorizations during insurance transitions
Increasing transparency around decisions and appeals
Expanding real-time responses for most requests
Ensuring qualified medical professionals review all clinical denials
With implementation deadlines spanning 2025 through 2027, the first major checkpoint has already passed, and the results are not encouraging. The AMA’s May 2026 follow-up survey found that the impact of these commitments has not yet materialized: only one in three physicians (33%) believe the pledge will make a meaningful difference, and just one in four (24%) report that medical necessity denials are consistently reviewed by appropriately qualified clinicians, despite that being an explicit part of the pledge. For now, providers and patients continue to face the same administrative challenges and care delays with little immediate relief in sight.
Can technology fix prior authorization? Not yet.
It is tempting to believe that technology could solve the PA headache. The reality is more complicated:
No universal solution: there is no single platform that can determine if a PA is required, submit a request, and receive a timely response across all payers. The industry’s electronic data interchange (EDI) standard, known as the 278 transaction, is not universally supported, and many insurers still rely on manual processes.
Fragmented adoption: some payers have adopted partial electronic solutions, but lack of standardization means providers still must juggle multiple portals, phone calls, and even faxes.
Growing complexity: insurers continue to expand the list of services requiring PA, compounding the administrative burden.
What does a high-performing PA team look like?
Prior authorization does not have to be a nightmare. Leading organizations are finding ways to make administrative work a smaller part of the day by:
Streamlined workflows: efficient teams minimize time spent on PA by leveraging smart processes and delegating tasks to specialists.
Reducing denials: addressing the root causes of denials ensures claims are correct the first time, improving cash flow and increasing the first-pass paid rate.
Outsourcing expertise: services like Access Healthcare’s PA team take on the administrative load, freeing up clinical staff to focus on patient care. Our team of prior authorization specialists delivers on-time authorizations more than 90 percent of the time with minimal disruption to client workflows.
Leveraging data analytics: using data analytics can help identify trends in denials, streamline workflows, and predict which requests are likely to be approved, leading to faster and more accurate PA submissions.
Tackling retroactive authorizations
By addressing the root cause of denied prior authorization claims, organizations get the claim right the first time, improving cash flow and increasing the first-pass paid rate. The result: happier staff, happier providers, and above all, happier patients.
Proactive authorization: preventing the need for retroactive PA is crucial, since approval after the fact is notoriously difficult, especially in scenarios like imaging, where a change in procedure (for example, adding contrast to a CT scan) can trigger a retroactive denial.
Appeals and follow-up: when retroactive approval is needed, a dedicated team, like Access Healthcare’s, increases the odds of success by meticulously documenting and appealing denied claims.
Turning bottlenecks into best practices
Obtaining PAs quickly improves the overall patient experience and minimizes, and in most cases eliminates, service delays. That is how everyone wins. While policy reforms and technology offer hope for the future, the most successful organizations are already focused on streamlining their PA processes through smart workflows, skilled teams, and targeted use of technology. The right partner corrects PA problems now, so care teams can focus on what matters most: patient care.
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