Health Insurers Promise to Fix Prior Authorization Delays

In June 2025, major U.S. health insurers, including UnitedHealthcare, CVS Health’s Aetna, Blue Cross Blue Shield, Cigna, and Humana, unveiled a transformative commitment to address one of the most persistent sources of consumer frustration: prior authorization. This process, requiring healthcare providers to obtain insurer approval before delivering certain treatments or medications, has long been criticized for causing delays, denials, and significant patient distress. According to a 2023 KFF survey, 19% of insured adults faced prior authorization issues, contributing to 65.2% of health insurance complaints in 2024 being related to claim handling delays. With reforms set to impact 257 million Americans across commercial, Medicare Advantage, and Medicaid plans, this blog post explores the promised changes, their implications, and practical steps for consumers to navigate the evolving health insurance landscape. Optimized for SEO, this guide aims to rank high on Google while empowering readers with actionable insights.

What Is Prior Authorization and Why Is It a Problem?

Prior authorization is a cost-control measure used by insurers to ensure medical treatments, procedures, or prescriptions are necessary before coverage is approved. While insurers argue it prevents overuse and ensures appropriate care, patients and providers often face significant challenges. The KFF 2023 Survey of Consumer Experiences with Health Insurance reported that nearly 1 in 5 insured adults encountered prior authorization issues, with Medicare Advantage plans denying 3.2 million claims in 2023 alone. The practice has grown more common as healthcare costs rise, particularly for prescription drugs, lab tests, physical therapy, and imaging exams like MRIs.

Key issues include:

• Care Delays: Patients experience wait times, sometimes weeks, for approvals, delaying critical treatments. Dr. Ashley Sumrall, an oncologist in Charlotte, North Carolina, notes that delays for routine MRIs can allow diseases like brain tumors to progress untreated, increasing patient anxiety—termed “scanxiety.”
• Denials of Necessary Care: About 6% of prior authorization requests are denied, even when medically justified, per KFF’s 2023 study.
• Administrative Burden: Providers face excessive paperwork and inconsistent insurer policies, diverting time from patient care. Sumrall highlights that “every insurer has their own way of doing business,” complicating the process.
• Lack of Transparency: Patients often receive vague denial explanations, leaving them unsure how to appeal or proceed.

The fatal shooting of UnitedHealthcare CEO Brian Thompson in December 2024 amplified public frustration, with many on X venting about prior authorization delays. These complaints underscore the urgency of reform, as delays can exacerbate health conditions and erode trust in the insurance system.

The 2025 Prior Authorization Reforms: What’s Changing?

On June 23, 2025, America’s Health Insurance Plans (AHIP) announced that major insurers would overhaul prior authorization over the next 18 months, impacting coverage through employer plans, individual markets, Medicare Advantage, and Medicaid. Supported by HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, the reforms aim to streamline processes and reduce consumer complaints. Key changes include:

1. Reduced Scope of Prior Authorization: Insurers will limit claims requiring pre-approval, focusing on high-cost or experimental treatments, sparing routine procedures like MRIs.
2. Standardized Electronic Processes: By the end of 2026, insurers will adopt uniform digital platforms for prior authorization, speeding up approvals.
3. Real-Time Responses: Insurers will expand real-time approval systems to minimize delays, particularly for urgent care needs.
4. Continuity of Care: Pre-approvals from a previous insurer will be honored for a transition period after a plan switch, ensuring uninterrupted treatment.
5. Enhanced Denial Reviews: Medical reviews will be mandatory for denied requests, providing clearer explanations and improving appeal chances.

AHIP President Mike Tuffin emphasized a “patients over paperwork” approach, aiming to enhance care access and reduce provider burden. Aetna President Steve Nelson added that the reforms go “beyond prior authorization,” focusing on better navigation and advocacy for members. However, the voluntary nature of these commitments, as noted by Oz, raises concerns about enforcement if insurers fail to deliver.

Impacts on Patients, Providers, and Insurers

The reforms promise significant improvements but come with challenges:

• For Patients: Streamlined processes could reduce delays, ensuring timely access to treatments. Clearer denial explanations will empower patients to appeal effectively. However, only 34% of insured adults are aware of their right to external appeals, highlighting the need for education.
• For Providers: Standardized systems and reduced prior authorization requirements will alleviate administrative burdens, allowing doctors like Sumrall to focus on patient care. Yet, the 18-month rollout means immediate relief is limited.
• For Insurers: While reforms may improve customer satisfaction, fewer denials could increase costs. Insurers must balance these costs with maintaining consumer trust, especially after high-profile incidents like the Thompson shooting.

The reforms follow increased scrutiny of the industry, with a May 2025 Justice Department complaint alleging illegal broker kickbacks by Aetna, Elevance Health, and Humana. Successful implementation could rebuild trust, but past efforts, like a 2018 initiative, fell short, fueling skepticism.

Navigating Prior Authorization in 2025: A Consumer Guide

While reforms are underway, consumers may still face challenges. Here’s how to navigate prior authorization issues effectively:

1. Understand Your Policy: Review your insurance plan’s prior authorization requirements, typically listed in your policy documents or on the insurer’s website. Contact customer service for clarification.
2. Submit Complete Documentation: Work with your provider to ensure all necessary medical records and justifications are included in the prior authorization request to avoid delays.
3. File an Appeal Promptly: If a claim is denied, review the explanation of benefits (EOB) for the reason. Submit a written appeal with additional documentation within the insurer’s deadline (usually 60–180 days). For urgent cases, request expedited internal and external reviews.
4. Engage a Patient Advocate: Advocates can assist with complex claims, ensuring insurers honor reform commitments. They’re particularly helpful for serious conditions requiring ongoing care.
5. Contact State Regulators: If the insurer’s response is unsatisfactory, file a complaint with your state’s insurance department. For example, Indiana processes complaints within 72 hours, requiring insurers to respond within 20 business days.
6. Request an External Review: In 44 states, you can request an independent review if internal appeals fail. Check with your state’s insurance department for details.
7. Use Ombudsman Services: Some states offer ombudsman programs or Consumer Assistance Programs to mediate disputes, though federal CAP funding ended in 2012.

Challenges and Future Outlook

The voluntary nature of the reforms poses a risk, as Oz noted that federal regulations could be imposed if insurers don’t comply. The 18-month timeline means patients may not see immediate changes, and historical failures, like the 2018 initiative, raise doubts. Only 24% of insured adults know which agency to contact for help, underscoring the need for public education.

Technological advancements, such as AI-driven approval systems and standardized digital platforms, could accelerate progress. The Indian insurance sector’s “phygital” model, combining digital and physical interactions, offers a potential framework for U.S. insurers to enhance consumer experiences. Long-term, these reforms could set a precedent for addressing other insurance pain points, like claim denials and billing disputes.

The 2025 prior authorization reforms by major U.S. health insurers mark a critical step toward addressing a major source of consumer complaints. By reducing the scope of prior authorization, standardizing processes, and enhancing transparency, insurers aim to improve care access for 257 million Americans. While challenges like slow implementation and public unawareness remain, consumers can take proactive steps by understanding their rights, appealing denials, and leveraging state resources. As the healthcare landscape evolves, staying informed and advocating for better policies will ensure these reforms deliver on their promise of a more patient-centered system.