Learn more about the ongoing effects of prior authorization on patients and physicians over the years. Explore relevant resources and news.
Resource | AMA
To assess the ongoing impact the prior authorization process has on patients, physicians, employers and overall health care spending, the AMA annually conducts a nationwide survey of 1,000 practicing physicians from a wide range of practice settings.
Resource | AMA
Explore the answers to frequently asked questions that you and your loved ones may have about the prior authorization process.
News | AMA
Melissa Garretson, MD, discusses how to talk to patients about prior authorization, why prior authorization takes so long, and how the AMA is fighting to fix prior authorization policy. AMA Chief Experience Officer Todd Unger hosts.
News | Medscape
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A 21-year-old with a rare cancer had to wait for prior authorization approval for proton therapy, and as a result, she faced several complications, needing a tracheostomy and feeding tube.
News | WTHR
First responders acted quickly to save Amanda Boley’s life using an air ambulance to transport her to the closest hospital. But Boley’s insurance said she should’ve obtained prior authorization for her emergency helicopter transport, even though she was unconscious, with no pulse. She had to fight for life and insurance coverage.
News | AMA
Many physicians fear the health insurance industry’s use of unregulated artificial intelligence automation and predictive technologies will increasingly override good medical judgment and systematically deny patients coverage for necessary medical care.
News | HME Business
Medicare Advantage prior authorization presents several challenges for home medical equipment (HME) companies, primarily due to administrative burdens, delayed care and financial strain.
News | NBC Chicago
When Jessica was diagnosed with Stage 4 cancer, her doctors prescribed both immunotherapy and chemotherapy – but her insurance company denied the prior authorization. After an appeal, dozens of phones calls and cries for help, Jessica’s once denied request was approved.
News | Kiplinger
When you are sick or in pain, the prior authorization process can be frustrating and will sometimes result in a denial. Knowing about the prior authorization denial rates within Medicare Advantage can help inform one’s choice during open enrollment.
News | AMA
AMA President, Bruce A. Scott, MD, shares his statement on Cigna announcing their intention to implement “tangible actions” to improve their prior authorization process. Now we await action for Cigna to formally commit and implement the proposed reforms.
News | Kaiser Family Foundation
This analysis uses data submitted by Medicare Advantage insurers to CMS to examine trends in the number of prior authorization determinations, denials, and appeals for 2019 through 2023, as well as differences across Medicare Advantage insurers.
News | Kaiser Family Foundation
A new KFF analysis found that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services and an even larger share of claims (37%) for out-of-network services in 2023.
News | STAT News
This article explores how painstaking and inequitable the prior authorization appeals process is, leaving patients with too big a hurdle to reverse a denial – while insurers profit.
News | AMA
AMA President, Bruce A. Scott, MD, shares his statement on the UnitedHealth Group vowing to simplify and accelerate their prior authorization process. “…It must be followed by substantive actions.” Read the full statement.
News | Kiplinger
People tend to like their Medicare Advantage plans — until they don’t. Consider the case of Rose LaChapelle, who says the Medicare Advantage plan that was supposed to provide care for her 92-year-old mother has failed her now that she needs it most.
News | Electronic Health Reporter
Health care access in the United States remains fraught with barriers, but none as pervasive as the issues surrounding prior authorizations, which have become one of the largest obstacles to timely and affordable health care.