Docs split: Prior auth relief or just another empty promise?
Key Takeaways
Industry Buzz
“We are pleased with the industry’s recognition that the current system is not working for patients, physicians or plans. However, patients and physicians will need specifics demonstrating that the latest insurer pledge will yield substantive actions to bring immediate and meaningful changes." — AMA President Bobby Mukkamala, MD
“The real problem currently is that utilization management will provide a prior authorization, but they don't look at all at the patient's policy… We also have insurance companies that continue to deny claims with a prior authorization so that we have to waste hours and hours appealing and working to get them paid. So, I think this plan is falling short of the full problem.” — @Traci S.
On June 23, 2025, a coalition of nearly 50 major health insurers—covering commercial, Medicare Advantage, and Medicaid plans for 257 million Americans—voluntarily pledged to streamline prior authorization processes.[]
Key commitments include:
Reducing prior authorizations by January 1, 2026
Standardizing the submission process for electronic prior authorizations by January 1, 2027, with a goal of 80% real-time approvals
Honoring existing authorizations 90 days after patients switch plans
Providing clear explanations of prior authorization decisions
Why doctors are cautiously optimistic
Physicians have long viewed prior authorization as one of medicine’s most onerous administrative burdens. In a 2024 American Medical Association (AMA) survey, nearly 90% of doctors reported that these hurdles contribute to burnout, with roughly 13 hours per week devoted solely to authorization tasks.[]
Forty percent of practices even employ staff dedicated to the process. Another survey revealed that around 93% of physicians had experienced care delays due to denials, with 29% reporting that prior authorization has led to “serious adverse events” as a result.[][]
"We are pleased with the industry’s recognition that the current system is not working for patients, physicians or plans."
— AMA President Bobby Mukkamala, MD
Nevertheless, many clinicians remain skeptical. Despite similar promises in 2018 and 2023, progress has been limited. As Dr. Mukkamala notes, “Physicians will need specifics demonstrating that the latest insurer pledge will yield substantive actions to […] break down unnecessary roadblocks.”[]
Medical Group Management Association’s (MGMA) Anders Gilberg notes that while CMS regulations and earlier consensus efforts outlined similar reforms, “year-after-year we continue to hear from physician practices that it is their number one administrative burden.”[]
Perspectives from docs working outside of medical associations like the AMA and MGMA are less optimistic, as seen in a discussion board under a Becker’s article on the topic.[]
One user (@OncoDoc) wrote, “Real reform would be that PA be done by a physician in the specialty that is requesting the service, and not a pharmacy tech or nurse or NPP or a physician in a different specialty. Why can a radiologist deny chemotherapy prescribed by an oncologist?”
Another commenter (@Traci S.) said, “The real problem currently is that utilization management will provide a prior authorization, but they don't look at all at the patient's policy. Too often we can get a prior authorization for a CPT code that isn't covered by the patient's policy; and of course find that out after payment is denied. We also have insurance companies that continue to deny claims with a prior authorization so that we have to waste hours and hours appealing and working to get them paid. So, I think this plan is falling short of the full problem.”
What it could mean for your practice
Fewer services needing approval: If plans meet the 2026 reduction goals, routine procedures (eg, MRIs and certain medications) could bypass authorization entirely. This frees up clinician and staff time and speeds up care.
Real‑time electronic approvals: By January 2027, an 80% real-time response threshold could eliminate multi-day phone and fax delays. This will decrease patient scheduling and improve satisfaction.
Continuity across insurers: The 90‑day carryover for existing authorizations allows more seamless patient transitions between plans during treatment—an advantage for specialists managing chronic conditions.
Transparency and appeal support: Clear, documented denial reasons and appeal guidance may reduce frustration and expedite resubmission and peer-to-peer review.
Lingering concerns
Voluntary nature: Without enforcement, plans may fail to deliver promised improvements. Federal officials, including Centers for Medicare & Medicaid Services’ Mehmet Oz, MD, and HHS Secretary RFK Jr., have warned of regulation if reforms fall short.
AI-driven denials: Insurers are increasingly deploying automated systems to adjudicate requests—systems that critics argue prioritize cost-cutting and have already led to increased denials.[]
Unspecified targets: While 80% real-time approval is a clear metric, reduction targets for services requiring authorization remain undefined, raising doubts about the magnitude of change.
The bottom line
This pledge represents a welcome shift toward less red tape. If insurers follow through, practices could see dramatic reductions in administrative burden, faster care delivery, and improved patient outcomes. But success depends on execution—and accountability.
For practices, now is the time to:
Monitor which services are affected in your insurers’ plans.
Ensure your EMR supports the standardized electronic system.
Train staff on new workflows and anticipate smoother appeals.
Track actual turnaround times and compare them to the pledge baseline.
As usual when it comes to proposed reforms like this, doctors must stay vigilant. If voluntary initiatives stall, supporting federal or state-level enforcement may be necessary to ensure meaningful, lasting change.
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