‘Delay’ and ‘Deny’: Even Health Insurance Companies Agree Prior Authorization Process Is Broken
Even health insurance companies now admit that the prior authorization process is broken. Major insurers including UnitedHealthcare, Cigna, CVS/Aetna, and Humana publicly acknowledged the problem in congressional testimony and industry statements — while still continuing to use prior authorization as a cost-control mechanism. Here’s what’s happening and what it means for Medicare enrollees in Arizona.
Insurers Admit the Prior Authorization Process Is Broken
The insurance industry’s own trade association, AHIP, has called for prior authorization reform — acknowledging that the current system creates unnecessary delays and burdens for patients and physicians. Several major insurers committed to reducing the use of prior authorization for certain services, following mounting pressure from Congress, physicians, and patient advocates.
But commitments and action are different things. Despite these acknowledgments, KFF research shows that Medicare Advantage plans continue to require prior authorization for a wide range of services — and denial rates remain high.
Why the Prior Authorization Process Is Broken by Design
The prior authorization process is broken not by accident but by financial incentive. Every time a prior authorization is denied and a patient doesn’t appeal, the insurer keeps the premium without paying the claim. The system financially rewards denial — which is why reform commitments rarely translate to meaningful change.
Common services requiring prior authorization in Medicare Advantage plans include:
- Inpatient hospital admissions
- Skilled nursing facility stays
- Chemotherapy and cancer treatments
- Imaging (MRI, CT scans)
- Home health services
- Durable medical equipment
What Congress and CMS Are Doing
The Centers for Medicare and Medicaid Services (CMS) has implemented new prior authorization rules requiring Medicare Advantage plans to make decisions faster and to align coverage criteria more closely with Original Medicare. However, these reforms don’t eliminate prior authorization — they only constrain how it’s administered.
The Alternative: No Prior Authorization Required
Original Medicare does not require prior authorization for most services. If Medicare covers a procedure and your doctor orders it, it’s covered — without an insurance company’s approval process standing in the way.
With a Medicare Supplement Plan G, your costs after the Part B deductible ($257 in 2026) are zero for covered services. No delays. No denials. No fighting with insurance companies.
Questions About Your Coverage in Arizona?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I don’t sell Medicare Advantage. I help Arizona seniors avoid the prior authorization process entirely by choosing Original Medicare with Plan G.
Call or text: (623) 742-3878
Email: andy@azhealth.us
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