When the nation’s largest health insurers said they were finally going to overhaul prior authorization last summer, physicians took notice. The ideas sounded great: make everything easier, reduce red tape, inject some real transparency, and actually put patient safety first—all before Jan. 1, 2027.
But the 2025 AMA prior authorization physician survey makes it clear that, so far, these promises remain just talk. It is nothing short of infuriating to see excessive prior authorization continue to hurt so many people.
The latest survey data makes that plain. Just one in three physicians believe the latest insurer pledge will make a meaningful difference for patients or the profession. If that sounds pessimistic, it is grounded in experience.
Credibility gap persists
The latest AMA survey reveals just how severe the prior authorization problem has become for physicians. With 1,000 practicing doctors responding, more than a quarter reported that prior authorization directly led to serious adverse events for their patients—including hospitalizations, permanent harm, and even death. Nearly all physicians said prior authorization delays critical care, and nearly four out of five have witnessed patients abandoning treatment because of these barriers.
Time after time, we have heard insurers promise voluntary action to address the headaches of prior authorization, only to see very little change in actual practice. A prime example: Insurers specifically promised that medical necessity denials would be reviewed by a licensed and qualified clinician. Yet only one in four surveyed physicians said this actually happens.
Worse, among those who participate in peer-to-peer reviews, just 16% say the insurer’s representative is consistently qualified to evaluate the relevant clinical issues. These are not small oversights. When clinical decisions are reviewed by unqualified personnel, patient safety and trust suffer.
The administrative burden is staggering. On average, each physician now completes about 40 prior authorization requests every week, and nearly one-third of doctors said their requests are often or always denied. This process demands around 13 hours of physician and staff time weekly, and 40% of practices have staff whose sole job is to deal with these requirements.
Far from creating efficiencies, prior authorization drives up health care utilization according to the vast majority of physicians—fueling unnecessary office visits, additional medications, emergency care, and hospitalizations. The numbers paint a clear and concerning picture of harm, disruption, burnout, and wasted resources across the profession.
UnitedHealthcare, Humana, Anthem/Elevance, Aetna, Cigna, and Blue Cross Blue Shield were each cited as sources of a “high” or “extremely high” administrative burden. Burnout, already at record levels across the profession, is further fueled by frustration over prior authorization processes that force physicians to choose between seeing patients and fighting payers for necessary care.
Impact of algorithms
Recent investigations and government reports indicate that the growing use of automation, predictive analytics and algorithmic decision tools by Medicare Advantage insurers has coincided with increased rates of prior authorization and postacute-care denials.
Evidence from congressional hearings, federal oversight agencies and litigation suggests that individualized determinations of medical necessity are increasingly being replaced by standardized, financially driven utilization-management practices.
Automated, unsupervised algorithms do not account for the complexities of individual patient needs and jeopardize the patient-physician relationship. The AMA continues to demand reforms that protect patients from such practices and ensure that care decisions are made by qualified clinicians, not by third-party algorithms or unproven predictive tools.
Solutions are attainable
Payers need to replace promises of prior authorization reform with the real thing. Insurers should provide clear, specific explanations whenever care is denied, including instructions for appeals, and ensure that prior authorization processes are simple, standardized and electronic. The volume and scope of prior authorization requests must be meaningfully reduced, especially for treatments with high approval rates or established clinical efficacy.
Patients deserve to have continuity of care protected during insurance transitions, so that approved authorization requests remain valid even if a patient changes plans. Prior authorization systems should be streamlined and automated, making them unified across all payers to eliminate unnecessary complexity and wasted time.
Finally, progress must be measured and verified. We need to see the data; individual insurance companies should openly share numbers on response times, approval and denial rates, and outcomes, so everyone can see if they are doing what they have promised.
From promises to progress
Prior authorization was originally conceived as a tool to reduce waste and ensure patient safety. Instead, our 2025 survey confirms it is too often a source of harm, inefficiency and stress for patients and physicians.
The AMA and our partners in the Federation of Medicine will never stop fighting to achieve real and lasting prior authorization reform at every level. That is what our patients deserve, what physicians everywhere need, and what our health care system requires. I invite you to share your story and join our fight.
