Prior Authorizations: Major Burden for 7 in 10 Insured Adults

Affordability remains the top economic concern for the public, but navigating the health care system itself presents significant challenges for many Americans. Recent findings highlight that prior authorizations – the process of obtaining insurance approval before receiving certain medical services – are a major source of frustration and burden for insured adults.

The Burden of Prior Authorizations

According to recent polls, approximately seven in ten insured adults find prior authorizations burdensome, with one-third describing it as a “major burden.” This surpasses the reported burden associated with understanding medical bills (60%), scheduling appointments (60%), or finding in-network providers (53%).

Did You Know? Nearly half (47%) of insured adults have experienced a denial or delay of a health care service, treatment, or medication in the past two years.

When asked to identify the single biggest burden beyond cost, 34% of insured adults chose prior authorizations. This sentiment is even stronger among those with chronic conditions, where 39% cite prior authorizations as their primary obstacle to care – more than double the percentage who selected other issues.

Impact Across Demographics

The burden of prior authorizations is felt across political affiliations and insurance types. While finding in-network providers is a significant concern for approximately 28% of Medicaid enrollees, prior authorizations are consistently identified as the top challenge for insured adults generally.

Delays and denials stemming from the prior authorization process are also widespread. Roughly two-thirds of adults consider these delays and denials a “major problem,” with over six in ten of those with Medicaid, self-purchased insurance, or employer-sponsored coverage sharing this view.

These issues translate into concrete experiences for many. Approximately 33% of insured adults report having a health insurance company deny coverage for a prescribed service, treatment, or medication within the last two years. Similar proportions (29%) have experienced delays in receiving care or been required to try alternative, lower-cost options first.

Expert Insight: The widespread challenges with prior authorizations suggest a systemic issue impacting access to necessary care, potentially leading to adverse health outcomes and increased financial strain for individuals, and families.

Negative Consequences

The consequences of denials and delays extend beyond mere inconvenience. One-third of those affected report a “major negative impact” on their mental health and finances, while one in four experience a significant negative impact on their physical health.

Frequently Asked Questions

What is a prior authorization?

Prior authorizations are a process where insurance companies require approval before covering certain tests, treatments, or medications.

Who is most affected by prior authorizations?

Insured adults with chronic conditions are particularly impacted, with 39% identifying prior authorizations as their single biggest health care burden.

What percentage of insured adults find prior authorizations burdensome?

Approximately 69% of insured adults find the prior authorization process burdensome, with one-third calling it a “major burden.”

As health care costs continue to rise, and administrative hurdles persist, it remains to be seen how these challenges will evolve and what solutions may emerge to improve access to care for all Americans.