Tradeoffs A Closer Look at a Widely Despised Health Insurance Policy
Sep 25, 2025
Prior authorization is a major roadblock for many patients seeking medical care, often delaying crucial treatments like chemotherapy. A caregiver shares her distressing journey through the system's confusion, highlighting the emotional toll. Experts discuss how prior authorization burdens both patients and clinicians, questioning its effectiveness as a cost-control tool. They propose meaningful reforms to streamline the process and reduce administrative burdens, emphasizing that the system should evolve to prioritize patient care.
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Scope And Consequences Of Prior Authorization
- Prior authorization affects about half of insured Americans and most requests are approved.
- It can be quick or cause long delays and outright denials that block care.
Delayed Approval During Cancer Care
- Kathleen and her husband Paul faced multiple delays from prior authorization during urgent cancer treatment.
- A 45-minute call revealed approval had occurred but the clinic wasn't informed, forcing personal advocacy to start care.
Urgent Scan Despite Insurer Hesitation
- After recurrence, a PET scan was urgently needed to map Paul's cancer and guide treatment.
- Insurer hesitated, so Kathleen and Tom proceeded with the scan and later learned the insurer agreed to pay.