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June 18, 2025
The Problems with Prior Authorizations: The AMA Produces Findings

The Problems with Prior Authorizations: The AMA Produces Findings

It was too much for high school basketball player Scott Howard (Michael J. Fox) who just found out he inherited his father’s werewolf gene: “Look, dad, I got a bad outside hook shot. I’m allergic to eggs. I got a $6 haircut. I mean, I have problems. I didn’t need this one!” I’m sure, at this point, many a medical professional has expressed similar sentiments. They’ve experienced diminishing reimbursement, increasing costs, greater burnout rates; and now—to add insult to injury—insurance companies are making it harder to get paid by forcing providers to face the ever-expanding prior-authorization hurdle. We didn’t need this problem!

The Problems with Prior Authorizations: The AMA Produces Findings

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Yes, according to the assessment of a growing number of industry experts, the increasing imposition of prior authorization requirements by health insurance plans is putting a significant strain on medical providers. And there are numbers to back this up.

Back in December, the American Medical Association (AMA) conducted a survey of 1,000 physicians. Among these were 400 primary care physicians and 600 specialists. One of the general findings of this survey, released earlier this month, was that prior authorizations “impose significant costs on the industry through additional unnecessary office visits, immediate care visits and hospitalizations.” Many physicians reported care delays, patients abandoning recommended treatment and serious adverse events associated with prior authorizations. 

In addition to these concerns, prior authorizations take a toll on the physician workforce, per the AMA. Here are 10 statistics that shed greater light on the effect prior authorizations are having on the medical community, as found in the AMA’s summary of its findings:

  1. On average, physician practices complete 39 prior authorizations, per physician, per week. 
  2. Physicians and their staff spend 13 hours each week on prior authorizations. 
  3. Forty percent of physicians have staff who exclusively work on prior authorizations. 
  4. Twenty percent of physicians said they always appeal an adverse prior authorization decision; about two-thirds said they do not appeal if they do not think the appeal will be successful; and more than half said they do not appeal if they have insufficient resources or time. 
  5. Thirty-one percent of physicians said prior authorizations are often or always denied. 
  6. Three in four physicians said the number of prior authorization denials has “increased somewhat or significantly” over the last five years. 
  7. Nearly nine in 10 reported that the prior authorization process somewhat or significantly increases burnout. 
  8. Sixty-one percent of physicians said they are concerned that AI will increase or already has increased prior authorization denial rates.
  9. Eighty-two percent of respondents indicated that prior authorizations at least “sometimes” lead to patients abandoning their appointments.
  10. Ninety-four percent said that the prior authorization process, itself, had a negative effect on patient clinical outcomes.

To help reduce administrative burdens and promote better patient care, the AMA, along with the American Hospital Association, American Pharmacists Association, Medical Group Management Association, America’s Health Insurance Plans and Blue Cross Blue Shield Association, released the “Consensus Statement on Improving the Prior Authorization Process” (CS) back in January of 2018. Unfortunately, despite being released nearly seven years ago, physicians report that health plans have made little progress in this area.

The AMA reports that, while UnitedHealthcare (UHC) and Cigna announced reductions in the number of services that require prior authorizations in 2023, only 16% of physicians who work with these payers reported changes that have reduced the number of prior authorizations completed for these plans. In addition, physicians report “consistently high prior authorization burdens across major health plans,” despite the commitments made in the above-referenced CS.

To see the full survey report, please click on the following link: AMA prior authorization (PA) physician survey | AMA.