By Paulette Jaeger, Vice President, Access Healthcare
A patient anxiously awaits a scheduled surgery but receives a call the night before at 7:20p.m. The procedure is postponed due to an unresolved prior authorization issue. The result? Delayed care, increased anxiety, and a missed opportunity for timely treatment. Unfortunately, this scenario plays out in clinics and hospitals across the country—all the time. But this time it happened to me.
Prior authorizations (PAs) remain a significant challenge in healthcare, causing delays and frustration for patients, physicians, and staff due to several systemic issues. Here’s a breakdown of why PAs continue to delay care and frustrate patients, physicians and staff.
The Administrative Burden on Physicians
According to the AMA, physicians will complete an average of 45 PAs per week, which can take between 12 and 33 minutes per PA depending upon its complexity. This consumes time that could be spent on direct 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, which is 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 (resulting in inefficiencies) or hire more staff to manage the PA process, minimizing 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:
More than 85 percent of patients face treatment delays
14 percent of physicians report that PAs consistently delay care
41 percent of physicians say PAs frequently delay care.
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 the last-minute cancellations that often occur when prior authorizations are not approved in time, as I personally noted above. For instance, a scheduled procedure can be cancelled on the eve or morning of the scheduled date 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 ORs remain unused, potentially 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 shouldn’t 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’s 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, with some not even offering an online portal to check PA status. This reliance on outdated technology also 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, major U.S. health insurers publicly committed to streamlining and simplifying PAs, promising steps such as:
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 medical professionals review all clinical denials
However, these changes are set to roll out gradually, with most improvements not expected until 2026 or 2027. 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’s 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 (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 doesn’t have to be a nightmare. Leading organizations are finding ways to win at PA by: "Make Administrative Work a Smaller Part of your Day"
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 our client’s 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 mitigating the root cause of a prior authorized denied claims, your organization gets the claim correct the first time, thus improving cash flow and increasing your first pass paid rate. Again, happier staff; happier providers and above all happier patients!
Proactive Authorization: Preventing the need for retroactive PA is crucial, as approval after the fact is notoriously difficult, especially in scenarios like imaging, where a change in procedure (e.g., 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.
The Takeaway: Turning Bottlenecks into Best Practices
As we’ve established, obtaining PAs quickly improves the overall patient experience and minimizes and, in most cases, eliminates service delays. This 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. Seek a solution that corrects your PA problems now, so you can truly focus on what is important—patient care and saving lives.
About the Author
Paulette Jaeger, Vice President of Sales at Access Healthcare, specializes in helping teams achieve successful revenue cycle processes, combining technology, workflow and staffing. Paulette’s passion is to assist the healthcare providers enhance their current RCM processes and be the most successful organization they can be. For many years, she worked in the field implementing and supporting clients during the implementation phases of technology and services and provided clients with ongoing consulting services and assisted them in achieving their goals.
Paulette has worked in all aspects of the revenue cycle with core focus on the front end and back end processes. She managed successful teams both sales and client success, ensuring client’s KPI’s were met and that they were successful in achieving their goals.
Paulette is committed to always learning and teaching and is passionate in building long-term relationships with her customers.
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