Prior authorization is costing lives. We can do better as a nation — and with your help, we will.

What is Prior Authorization and Why is it Harmful?

Definition

Prior authorization is a requirement from insurance companies that a healthcare provider must obtain approval before prescribing certain medications, procedures, or treatments.
Why It’s a Problem

• Delays in care: 94% of physicians say prior authorization delays necessary treatment.
• Denials without explanation: Insurance companies often deny requests, forcing patients to appeal.
• Physician burden: Doctors spend an average of 13 hours per week on prior authorization paperwork instead of patient care.
Example

A cancer patient is prescribed a life-saving treatment, but insurance requires prior authorization. The process takes weeks, delaying critical care.
Solution

We support legislation that removes prior authorization for essential treatments and ensures decisions are made by qualified medical professionals.

Who Decides if Your Care is Covered?

Does a doctor deny my claim?

Most people assume that a doctor is responsible for approving or denying an insurance claim. In reality, many claims are reviewed by individuals with no medical training.
Who Reviews Your Claim?

• Medical directors (rarely involved) – Some insurance companies require a licensed doctor to oversee decisions, but they don’t review every case.
• Claims adjusters – Often people with only a high school diploma or limited training in insurance policies.
• Third-party contractors – Hired by insurance companies to process claims quickly, sometimes with incentives to deny coverage.
Key Fact

In 2023, the American Medical Association found that 25% of denied claims were overturned on appeal—proving that many denials were unjustified in the first place.
Solution

We are advocating for legislation that ensures medical professionals with relevant expertise review claims, not corporate employees with financial incentives to deny care.

The Cost of Denied Care: Real-Life Consequences

💰 66% of bankruptcies in the U.S. are due to medical bills—even for insured patients.

⏳ Average appeal wait time for a denied claim: 30-90 days.

🩺 Medical harm: 34% of doctors report that prior authorization has led to severe patient harm due to treatment delays.

Real Stories

Lisa, 45

🆘 Lisa was diagnosed with multiple sclerosis. Her doctor prescribed a new medication that could slow her disease progression. Insurance denied it, forcing her to use an older, less effective drug. After two years, her condition worsened to the point where she lost mobility.as diagnosed with multiple sclerosis. Her doctor prescribed a new medication that could slow her disease progression. Insurance denied it, forcing her to use an older, less effective drug. After two years, her condition worsened to the point where she lost mobility.
John, 60

🚑 John suffered a heart attack. The hospital billed $120,000. His insurance company first approved coverage but later denied it, citing a “coding error.” John was left in debt.

Know Your Rights:

✅ Request a written reason for any denial.

✅ File an appeal—60% of appeals are successful.

✅ Ask your doctor to write a medical necessity letter.

✅ Contact your state insurance commissioner if an insurer is acting unfairly.

Join the Movement:

📢 Share your story – Your experience can help change policies.

📨 Contact lawmakers – Tell them to pass stronger patient protection laws.

💰 Donate to the cause – Help us fight insurance abuses.