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Prior Authorization

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By EMANUEL SARKEES

Most people have never heard of prior authorization until it personally stops them from getting care they actually need. The way it usually goes is pretty straightforward: a doctor sees a patient, figures out what is wrong, decides on a treatment, and writes the order. Then everything stops. Before anything can actually happen, the insurance company has to sign off. What makes this so frustrating is that it is not really one problem. It is a bunch of problems stacked on top of each other, where each one makes the next worse. Doctors lose hours, patients lose access, outcomes suffer, and the people who built the system are not the ones dealing with what it does to real patients.

Insurance companies say prior authorization is about preventing unnecessary care and keeping costs down. That argument has some logic to it on paper. But what the process actually looks like day to day has very little connection to that original idea. Doctors are drowning in paperwork, patients are waiting on treatments their physicians already approved, and outcomes are worse because of delays that did not have to happen. It was built to contain costs. What it is containing instead is care, and the patients on the receiving end had no say in how any of it was designed.

How It Works and Why It Doesn’t

A physician submits a request to an insurance company before prescribing a medication, ordering a procedure, or sending a patient to a specialist. The insurer looks at it and decides yes or no. That decision is supposed to come from a qualified medical professional who actually reviews the clinical picture. The data suggests that is not really what is happening.

The AMA’s 2025 physician survey found that the average doctor handles 40 prior authorization requests every week, eating up roughly 13 hours of their time. Almost two full working days every week are spent on paperwork instead of patients. Ninety-five percent of physicians surveyed said prior authorization gets in the way of necessary care. Seventy-nine percent said patients give up on treatment entirely because the process is too much or the approval never arrives.

What that produces is not an inconvenience. It is documented harm. A Johns Hopkins systematic review from September 2025 went through 25 studies and found prior authorization tied directly to disease progression, unnecessary hospitalizations, longer hospital stays, and lower survival rates in cancer patients. One in four physicians said a prior authorization delay had caused a serious adverse event for a patient, including permanent impairment or death. A RAND analysis from July 2025 pulled specific cases, including a kid with newly diagnosed Type 1 diabetes waiting in a hospital bed for approval on basic insulin, and an infant in respiratory distress turned away because a medication that was not even indicated had not been given first. These are not flukes. They are what happens when administrative decisions consistently override clinical ones with no real accountability in the process.

Who Gets Left Behind

Prior authorization does not land the same way for everyone. Low income patients and Medicaid patients face the highest denial rates and have the fewest realistic options when a denial comes through. Appealing takes time, paperwork, and persistence that is hard to maintain when you are working multiple jobs or dealing with a language barrier. For a lot of people the appeal never gets filed. The treatment gets dropped.

A 2025 KFF Health Tracking Poll found that 58% of insured adults who needed specialized care ran into a delay or denial because of prior authorization. For lower income patients that number is higher, and the consequences are more serious because there are not many alternatives when the answer is no. This fits a pattern that keeps showing up across American healthcare. People without insurance face it when they cannot afford to walk in the door. Low income patients face it when something is technically covered but impossible to access. Insured patients now face it when their doctor has already made the call and an insurance company decides differently. The wall keeps appearing in different places. It keeps stopping the same people.

The Promises Being Made

Some things have actually changed and it is worth acknowledging that.

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The Uninsured Crisis: Letter from Arizona

By EMMANUEL SARKEES

Arizona consistently ranks among the states with the highest uninsured rates in the nation. Over 800,000 residents lack health coverage, a number shaped not by failure, but by a consistency of structural, geographic, financial, and linguistic barriers that have been poorly addressed for decades. What makes Arizona’s situation this severe is that the demographic makeup, geographic issues, policy history, and high uninsured rate do not exist as separate problems, but as a link of issues where each difficulty increases the next.

In the United States, health insurance is not just a financial factor, but it is the primary mechanism through which people gain access to healthcare. Without insurance, an annual checkup becomes a pricey luxury, a chronic illness becomes undealt with, and a slight emergency can devastate someone’s life finances. This can be seen at its highest in Arizona, where Arizona ranks 43rd in the nation for its uninsured rate at 10.3%, carrying higher rates of disease mortality and late stage sickness as a result.

Who Arizona’s Uninsured Actually Are

One of the most common misconceptions about uninsured communities is that they are mostly unemployed. In Arizona, that is simply not accurate. A huge part of the state’s uninsured population works full time in agriculture, construction, and food service, where there is a shortage of health benefits. Although coverage is technically available through an employer, the costs to maintain these benefits are often too high in relation to their earnings. This leaves a large group of people in an unfortunate circumstance: they make too much to qualify for AHCCCS, Arizona’s Medicaid program, but too little to afford insurance plans. They fall into a coverage gap that lacks a current policy built to close it.

The data is also clear that the consequences do not distribute evenly. Hispanic and Latino residents are uninsured at higher rates than white Arizonans, while Native American and Indigenous people endure similar circumstances, surged through the federal government’s history of underfunding tribal healthcare and the fact that these communities often live in remote areas where there is a lack of healthcare infrastructure. Geography adds to this further, as uninsured rates are highest in rural and border areas like Yuma, Santa Cruz, Apache, and Navajo, communities that already greatly lack economic opportunities and healthcare infrastructure compared to urban areas like Phoenix and Tucson.

What Happens When People Can’t Get Care

All of these barriers have real consequences. Conditions that are quite easy and simple to treat become serious issues by the time they are finally caught. Social factors like insurance status stand as one of the greatest predictors of whether someone gets cancer and whether they survive it. Late stage cancer diagnoses are not just bad luck, but in some cases, are dependent on whether the patient was able to access the routine checks that would have easily caught it earlier.

Chronic conditions like diabetes and hypertension are another area where being uninsured causes serious, life-altering harm. These conditions need to be managed consistently with regular checkups and medication. Uninsured people often cannot afford visits or medication, so the conditions go unmanaged and worsen over time. A striking example: GLP-1 medications increased 442% in price between 2021 and 2023, creating a market three times larger than cancer spending, with list prices reaching $1,400. The fundamental issue is not just prices, but a system where everyone is focused on maximizing revenue rather than patient outcomes.

When uninsured patients consistently resort to the emergency room because of a lack of options, those costs do not disappear.

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