Everyone in America will eventually depend on the healthcare system, yet getting the care a doctor recommends can mean fighting through weeks of insurance paperwork. We must fix prior authorization and demand healthcare AI that understands clinical evidence, insurance policies, and state regulations. Otherwise, we risk building a future where technology accelerates administrative mistakes while patients suffer preventable harm.
Prior authorization requires doctors to obtain an insurer’s approval before certain treatments or medications can be covered. The goal is safe and effective care while maintaining cost. In practice, the process too often turns physicians into clerical workers and patients into collateral damage.
Modern medicine can perform extraordinary feats, but those capabilities mean little when administrative barriers prevent patients from accessing treatment. According to the American Medical Association’s 2025 Prior Authorization Physician Survey, physicians and their staff spend an average of 13 hours each week completing authorizations, handling approximately 40 requests per physician. Ninety-five percent of surveyed physicians report treatment delays, 79 percent say authorization problems can lead patients to abandon treatment, and 94 percent say the process contributes to burnout.
Most alarming, 26 percent report that prior authorization has caused a serious adverse event for a patient. These are warning signs of a system that can turn a treatable condition into a medical crisis. The underlying problem runs deeper than excessive paperwork.
Healthcare decisions depend on context, and that context changes constantly. The appropriate treatment criteria may vary by insurer, insurance product, diagnosis, and state. A commercial health plan and a workers’ compensation policy from the same insurer can follow different rules.
Consider a physician treating a patient with a rotator cuff injury. Whether the tear is acute or chronic can affect the relevant treatment criteria. If the doctor consults the wrong guideline, misses a documentation requirement, or relies on an electronic health record checkbox that fails to capture the insurer’s exact criteria, a necessary treatment may be denied.
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