Sometimes [prior authorization] INCREASES the cost of care, which it is intended to combat. For example, certain higher level imaging studies are needed, no matter what, to evaluate for a condition. Carriers have blanket requirements that lower-level imaging be performed first, and in certain cases, this lower-level imaging will not help at all- it will not change the fact that the higher-level imaging is necessary. So, insurers are REQUIRING that we order two studies instead of one. The alternative is to send a patient through the ER, which is clearly not cost-effective for a condition [that] can be managed at the outpatient level. This is unnecessary, wasteful, and contributes to increased costs for all. All of this AND calling to do a "peer-to-peer" discussion has no impact: the "peer" can't waive the lower-level imaging requirement even when they medically agree, and it takes up at least 30 minutes of time, which would easily be 1-2 more patient visits.