Prior Authorization Is About Payments, Not Patients

I’ve said this before, and it probably doesn’t bear repeating. But for some reason, I end up writing a lot about prior authorization (PA).

Because I write a lot about PA, I’ve come to three conclusions:

• PA is an issue between providers and payers, not patients.
• Most people don’t follow the PA issue between providers and payers similar to how most don’t follow public health and healthcare issues generally.
• PA is the biggest waste of time and money in healthcare.

A new Kaiser Family Foundation (KFF) consumer tracking poll does nothing to change my mind about those three conclusions. KFF conducted the poll of 1,283 U.S. adults age 18 or older earlier this month.

Some 73% of the poll respondents said delays and denials of healthcare services by health insurers are a major problem. That’s like asking consumers whether they thought wildfires started by arsonists were a major problem. Of course they are. The KFF question doesn’t ask respondents specifically about PA. If I were a judge and this was a trial, I’d toss that question for relevance.

Here’s the relevant stuff:

• 79% said they hadn’t heard about the latest voluntary commitment by health insurers to reduce the burden of PA.
• 61% said it was “not too likely” or “not at all likely” that health insurers would follow through on that commitment, which HHS extracted from them.
• 51% said their health plans required them to get PA approval sometime over the past two years before receiving treatment or service.
• Of those respondents who said they needed PA approval, 53% said getting it from their health plan was “very easy” or “somewhat easy.” For Medicare beneficiaries, that percentage was even higher: 72%.

The results are a big yawn. That didn’t stop KFF from putting this misleading headline on top of its report: “Public Finds Prior Authorization Process Difficult to Manage.” No, the public didn’t. But that won’t stop the healthcare trade press from regurgitating KFF’s headline.

The results actually mirror the results of a survey of 1,005 patients conducted by four researchers from Harvard, McKinsey & Company, Stanford and the National Bureau of Economic Research. They did their survey in 2023 and published their results in 2024. I wrote about them last fall in this blog post, “Patients Shrug at Prior Authorization.”

In that survey, 88% of patients said they had an overall favorable opinion of PA, and 87% said provider PA processes were efficient.

Separately, in this blog post, “Tell Me Again Why We’re Doing Prior Authorizations?” I wrote about yet another piece of research that found that more than 83% of PA denials were overturned on appeal.

PA simply is a process through which payers try not to pay claims and providers try to get claims paid.

Nothing more, nothing less. And because it’s about payments, not patients, it’s never going away.

Thanks for reading.