If your doctor recommended a test or treatment only for your insurance provider to demand more paperwork first, you’re not alone. That obstacle, known as prior authorization, has become a notorious bottleneck in the U.S. health care system, delaying care and frustrating both patients and providers.
About 16% of insured adults say they’ve run into issues with prior authorization, according to a survey by the Kaiser Family Foundation. And it’s more than just an inconvenience — it’s part of a larger problem. Americans pay more for health care than anyone else in the world, but still face worse outcomes and declining life expectancy, even as premiums, prescription prices and hospital costs continue to climb.
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Now, federal officials say help may be on the way. Health and Human Services Secretary Robert F. Kennedy Jr. announced that several of the country’s largest insurers have pledged to overhaul the system and reduce delays.
While that sounds promising, some experts are urging caution.
“I think the question is whether this is actually going to come to fruition,” said Miranda Yaver, a health policy professor at the University of Pittsburgh, in an interview with National Public Radio (NPR). “We’ll have to see to what extent they make good on their promise, because right now, it is a pledge.”
Red tape’s breaking point
Prior authorization has long been one of the most unpopular parts of the U.S. health care system.
Despite years of promises from insurers to fix it, little has changed. At a press event on June 30, Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services (CMS) administrator Dr. Mehmet Oz acknowledged that this isn’t the first time insurers have promised to streamline the process.
So what’s different now?
“There’s violence in the streets over these issues,” Oz said, referencing the 2024 killing of former UnitedHealthcare CEO Brian Thompson — a tragedy that shook the health care industry and sparked widespread outrage. The man charged with Thompson’s murder, Luigi Mangione, had long posted his struggles with insurance denials and mounting medical debt. He frequently wrote about living with chronic back pain and expressed anger over being denied the treatments he believed he needed.
A survey by the National Opinion Research Center (NORC) at the University of Chicago found that about 7 in 10 adults believe insurance denials or the profits earned by health insurance companies bear at least “a moderate amount” of responsibility for Thompson’s death.
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What’s changing
Federal health officials say the process should become faster, clearer and less frustrating by the end of the year. The Department of Health and Human Services, alongside AHIP, the main lobbying group for insurers, says the initiative includes six key changes:
- Move prior authorization online, replacing outdated systems with streamlined digital platforms.
- Cut red tape by reducing the number of services that require prior approval.
- Make approvals portable so patients don’t have to start over when they switch insurance mid-treatment.
- Boost transparency so patients and providers get timely updates on decisions and know how to appeal.
- Fast-track the routine care by granting instant approvals for common treatments.
- Require that licensed medical professionals review all clinical denials.
Still, officials acknowledge this won’t be a simple fix. Even as agencies work to reduce bureaucracy, they’re facing their own obstacles. The Trump administration and some Republican lawmakers are backing proposals that would require certain Medicaid recipients to regularly prove they are working to keep coverage.
Whether these reforms lead to meaningful relief or just more promises remains to be seen.
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This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
