Last year, insurers made a series of commitments to streamline prior authorization, including improving transparency and standardizing electronic prior authorization. The commitments are being implemented throughout 2026 and 2027.
However, a new survey from the American Medical Association reveals that physicians are still skeptical. Only one in three physicians (33%) believes the commitments will make a meaningful difference in prior authorization, according to the survey. It surveyed 1,000 practicing physicians.
The commitments include requiring all medical necessity denials to be reviewed by a licensed, qualified clinician, but only 24% of physicians say those reviews are consistently conducted by appropriately qualified clinicians. Another 16% of respondents who participate in peer-to-peer reviews report that the health plan representative “often or always” has the right qualifications.
“Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises,” said Dr. Bobby Mukkamala, AMA president, in a statement. “Physicians are especially frustrated when so-called peer-to-peer reviews are conducted by individuals who lack the appropriate clinical expertise to evaluate a patient’s care. When only a third of physicians expect meaningful impact—and so few report that health plan reviewers are appropriately qualified—it highlights a credibility gap that won’t be closed with vague or partial measures.”
The survey also found:
- About 26% of physicians say that prior authorization has caused a serious adverse event, and 95% report that prior authorization delays access to necessary care.
- About 79% of physicians say that patients abandon care because of prior authorization issues.
- Physicians do 40 prior authorizations a week on average. About one in three reports that requests are “often or always denied.” In addition, 94% report that prior authorization contributes to burnout.
- Another 74% of physicians say that denials have increased in the last five years. About six in 10 are concerned that AI will increase denials even more.
- Physicians and staff spend about 13 hours a week on average on prior authorizations.
- About 88% of physicians say that prior authorization increases overall healthcare utilization, largely because requirements lead to ineffective initial treatments, additional office visits, emergency care and hospitalizations.
- Physicians report persistently high administrative burdens tied to prior authorization across major health insurers, with UnitedHealthcare ranking highest at 75%, followed by Humana at 65%, Elevance/Anthem and Aetna at 61%, Cigna at 59%, and Blue Cross Blue Shield plans at 56%.
Gaining physicians’ trust will not be an easy task.
“Rebuilding trust will require sustained, transparent, and measurable action to streamline prior authorization and keep it clinically focused and patient-centered,” Mukkamala said. “Anything less risks reinforcing the skepticism these pledges were meant to address.”
Photo: Piotrekswat, Getty Images
