Articles & Education
Prior Authorization: Roadblock to Care
March 10, 2025
82% of physicians had at least one patient who did not seek treatment because of prior authorization.
If you’ve had health care services or a prescription delayed or denied, there’s a good chance your insurer’s prior authorization requirements are the reason. The process can be frustrating and harm your health.
Has your health care been delayed or denied due to prior authorization? Share your story.
When your doctor or caregiver recommends treatment, they work directly with you — using their knowledge of your condition and their professional judgement — to identify a plan to deliver the best care. Insurers have roadblocks in place to slow this process down.
Insurers often have medical staff to review claims, and sometimes use sophisticated mathematical algorithms or artificial intelligence, to deny your physician’s recommended care. In some cases, hundreds — if not thousands — of requests are processed in a matter of seconds. When care — scans, treatments and medication, for example — is denied, your physician must navigate the cumbersome justifications process and pursue appeals to the insurer’s rejection.
These requests for authorization often result in approval. However, insurers’ delay-deny system can harm a patient’s health as treatments await approval, expand health care bureaucracy without creating value for patients and reduce caregivers time with their patients.
Legislation being considered by the Missouri General Assembly would reduce this burden for patients and their physicians, eliminating the prior authorization process for providers with a history of ordering diagnostics and treatments only when medically appropriate. It encourages providers and insurers to work together to establish appropriate utilization patterns, achieve quality metrics and enter into value-based care arrangements that produce better outcomes for patients without unnecessary administrative burdens. The legislation also provides insurers with appropriate review and oversight of providers to prevent abuse.