claim denial rates Prior
authorization
travesty

August 24, 2026 -- Insurance companies practice medicine? Yes, when it boosts profits. It's called prior authorization and it has nothing to do with keeping people healthy.

"Prior authorization is a health plan cost-control process that requires physicians and other health care professionals to obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage." [Source: AMA] claim denial rates

In Health insurer CEO: "Make prior authorization illegal" today, Becker's Hospital Review writes:

A KFF analysis of the first year of reported data from 2025 found that insurers denied between 12% and 18% of prior auth requests across Medicare Advantage, Medicaid managed care and the ACA marketplace. When patients appealed, 67% of MA denials were overturned, 47% in Medicaid and 43% on the marketplace. Centene overturned 93% of its appealed MA denials.

"We are creating massive amounts of waste in our system, and we are controlling cost within the system simply by denying care," [said] Patrick Quigley, CEO of Sidecar Health.

...The advocacy group American Economic Liberties Project publish[ed] a policy brief that called for an outright ban on prior auth as it currently exists, arguing that the practice has become a "corporate care veto" that ...boosts insurer profits rather than protects patients.

It overrides healthcare providers' decisions. Patients often suffer worsened clinical outcomes due to what is in effect denial of care. It also increases paperwork and administrative costs. And in the majority of cases when denials are appealed, denials are overturned.

Make prior authorization illegal indeed!