Prior Auth Still Adversely Affecting Physicians Despite Health Insurers’ Pledge
By Phil West

Despite a health plan advocacy group’s public pledge to “streamline, simplify and reduce prior authorization,” a newly released physician survey shows insurers’ practices continue to adversely affect physicians and their patients.

The 2025 edition of the American Medical Association’s prior authorization physician survey contends insurers’ policies limits patient access to care, exacerbate physician burnout, and delay necessary treatments – sometimes leading to serious adverse events including hospitalization, disability, or even death.

“Prior authorization still is a major stress,” said Texas Medical Association President Bradford W. Holland, MD. “It’s time-consuming for a physician in a practice, it delays patient care, and, in many instances, it hurts patients, because delayed care often has the same effect as denied care.”

The latest 44-question AMA survey polled 1,000 practicing physicians – 600 specialists and 400 primary care doctors – across the U.S. in December 2025.

The AMA asked whether insurers are honoring a June 2025 pledge by the national trade association for the health insurance industry, AHIP (which recently rebranded from America’s Health Insurance Plans), under which more than 60 health insurers committed to:

• Standardizing electronic prior auth;
• Reducing the scope of claims subject to prior auth;
• Ensuring continuity of care when patients change plans;
• Enhancing communication and transparency on determinations;
• Expanding real-time responses; and
• Ensuring medical review of nonapproved requests.

Physicians’ skepticism about insurer-initiated reform persists, as the survey found:

• Only 33% of physicians believe it likely that commitments those insurers made will make a meaningful difference for patients and physicians;
• Only 24% agree that denials based on medical necessity for clinical factors are being reviewed by a licensed and qualified clinician; and
• Only 16% of physicians participating in peer-to-peer reviews say the peer reviewer often or always has the appropriate qualifications.

A majority of respondent physicians, ranging from 56% to 75%, rated the prior auth burden as “high” or “extremely high” for each of six major insurers.

An otolaryngologist with Coryell Health in Gatesville and Waco, Dr. Holland can attest to those findings citing ongoing obstacles, including difficulties scheduling peer-to-peer reviews of denied procedures.

Prior auth also continues to impact physicians’ well-being. The share of respondent physicians reporting either a “somewhat” or “significant” increase in prior auth-related burnout grew from 89% in 2024 to 94% in 2025.

Among the patient impacts noted by survey respondents:

• 95% of physicians report care delays associated with prior auth;
• 92% report perceiving prior auth has a somewhat or significant negative overall impact on patient clinical outcomes;
• 79% report that prior auth sometimes, often, or always leads to patient abandonment of treatment; and
• 26% report that prior auth has led to a serious adverse event for a patient in their care.

Based on the survey’s results, on average, practices complete 40 prior authorizations per physician, per week, consuming 13 work hours per week for physicians and staff. The survey also found 60% of respondent physicians worry that the use of AI will increase denial rates.

Thanks to member-driven advocacy, TMA has long sought prior auth reform, such as state gold-card legislation passed in 2021 and reinforced in 2025. The 2027 Texas legislative session could bring potential for further TMA-backed protections. Last October, California passed a law phasing out prior auth for services with high approval rates and requiring greater transparency – a model that could inspire similar legislation.

Meanwhile, Dr. Holland stressed TMA must remain vigilant in monitoring state-regulated health plan compliance with Texas’ gold-card law.

Learn more about TMA’s ongoing advocacy efforts.