For years, patients and doctors have struggled with the complex and time-consuming insurance process known as prior authorization, a requirement that doctors obtain approval from insurers before proceeding with prescribed treatments. 

Patients and doctors often find themselves lost in endless forms, vague rejection letters, and last-minute denials that can delay, or outright block, needed treatment. 

This may be about to change. 

In the aftermath of the fatal shooting of the UnitedHealthcare CEO, Brian Thompson, in Manhattan six months ago — and rising public criticism of insurers — the Trump administration has decided to do something about it.

In late June, major insurers pledged to the government that they would voluntarily scale back these controversial tactics, which have long been condemned as prioritizing profits over patient care.

“Prior authorization reform is essential to reducing the red tape that has long burdened American patients and providers,” the press secretary for the Department of Health & Human Services, Vianca Rodriguez Feliciano, tells The New York Sun. “As Secretary Kennedy and Administrator [Mehmet] Oz recently stated, this is a critical step toward ensuring timely, evidence-based care.” 

The Centers for Medicare & Medicaid Services, which Dr. Oz leads, is rolling out a pilot program that uses advanced technology to “expedite the prior authorization process in Original Medicare, helping prevent unnecessary or inappropriate care while protecting taxpayer dollars,” Ms. Feliciano explained. 

It’s part of a broader push by federal health officials to tighten oversight of Medicare spending and root out fraud and waste.

The Impact of Pledged Changes 

The vow to overhaul the prior authorization process could affect up to 257 million Americans, according to America’s Health Insurance Plans, a trade association representing the industry. 

Prior authorization affects roughly 85 percent of Americans and, in some tragic cases, has been tied to patient harm or death. However, the agreement to improve the process isn’t formally set in stone. 

“Voluntary commitments don’t guarantee relief for physicians or meaningful improvements for patients, but we are hopeful despite past broken promises,” the senior vice president of government affairs for the Medical Group Management Association, Anders Gilberg, tells the Sun. 

“While MGMA is ultimately looking to reduce the overall frequency and number of services requiring prior authorization, improving the speed of approvals through the use of technology will help eliminate delays in care,” he says.

Key changes, starting next year, include honoring prior authorizations for 90 days after patients switch plans, requiring clearer denial letters with appeal instructions, and ensuring all denials are reviewed by medical professionals. 

By 2027, insurers say they aim to process 80 percent of electronic requests in real-time and move most submissions online. While insurers also hinted at reducing the number of services requiring prior approval in some regions, they offered few specifics.

So, what is behind the sudden change of heart?    

The dean of the Robert F. Wagner Graduate School of Public Service at New York University, Sherry Glied, tells the Sun that the biggest risk factors for these conglomerates in not complying is likely “public pressure and reputational risk.”

“Currently, insurers primarily compete on price and network breadth. If employees and employers are dissatisfied with the level of administrative burden and are willing to accept slightly higher premiums to reduce hassle costs, I’m sure insurers will respond by reforming their practices,” she continued. 

“Otherwise, there may be a few regulatory attempts to address this, but it is very hard to enforce.”

Yet something is different now: the public mood has shifted, and there is a brighter spotlight on insurance companies’ treatment of people over profits. 

The fatal shooting of Thompson ignited renewed scrutiny of insurance practices — especially prior authorization, which many blame for delayed or denied care. 

A 27-year-old Ivy League graduate from a prominent Maryland family, Luigi Mangione, is accused of fatally shooting the UnitedHealthcare CEO. He faces both state and federal charges, including second-degree murder, terrorism, and stalking, with prosecutors seeking the death penalty. Mr. Mangione has pleaded not guilty, and trials are expected to begin in 2026.

While insurers have long defended the prior authorization process as a tool to control rising medical costs, they’ve acknowledged the need for reforms.

Prior authorization currently incurs nearly $20 billion in annual administrative costs for providers, with doctors spending an average of 12 hours a week navigating approvals instead of treating patients, according to the American Medical Association. These delays often prevent timely access to critical care. More than half of insurers’ denials are overturned on appeal, fueling criticism that the system is inefficient, subjective, and often harmful.

Analysts warn, however, that prior authorization isn’t disappearing — even as these minor changes may help simplify certain parts of the process. 

“Streamlining will reduce delays for approvals and the administrative burden on providers. This will reduce frustration among consumers if the degree to which these reforms occur are substantial,” the Bloomberg distinguished professor at Johns Hopkins, Daniel Polsky, a health policy and economics analysts, tells the Sun. 

Yet insurance companies “will still have the power to say ‘no’ to things that both patients and providers want insurance to cover,” he adds.

In other words, optimizing and expediting the approval process for medical care will help doctors and nurses spend less time on paperwork, and patients won’t have to wait as long to receive the care they need. That will make things less frustrating — if the changes are significant enough to work. 

However, the insurance companies (or Medicare) still get to decide what they will and won’t pay for. Even with improvements, people may still feel upset if they’re denied coverage for treatments they believe they need.

A rule is already in place that ensures Medicare Advantage plans honor existing approvals for 90 days after enrollees change their coverage. What’s different now is that these reforms will also apply to private insurance, affecting a far greater number of Americans.

Still, there’s deep skepticism that insurers will follow through on a voluntary promise with no legal teeth. 

What Happens Now

Similar promises were made in 2018 and 2023 with little follow-through, and regulators admit the latest reforms are voluntary. Critics argue that insurers have had decades to address the issues but haven’t followed through, contending that more profound changes are necessary to eliminate the barriers that insurance companies create. 

In a statement to the Sun, the American Medical Association noted that this is the “third pledge in seven years to improve and simplify the pre-treatment authorization process.”

“Patients and physicians will need specifics demonstrating that the latest insurer pledge will yield substantive actions to bring immediate and meaningful changes, break down unnecessary roadblocks, and keep medical decisions between patients and physicians,” the American Medical Association president, Bobby Mukkamala, said.

Insurers also continue to defend prior authorization as a necessary cost-control tool, arguing it helps prevent the overuse of expensive and sometimes unnecessary treatments. 

However, if insurers have already made vows on this matter in the past yet failed to initiate change, why would they act differently this time around?

“There’s violence in the streets over these issues,” Dr. Oz said at a June press event, alluding to the targeted killing of Thompson. “This is not something that is a passively accepted reality anymore — Americans are upset about it.”

While many skeptics contend that the efforts don’t go far enough and the pledges are not tied to clear targets, such as the number of prior authorizations to be removed, federal health officials insist that, though this is all voluntary, there will be noticeable improvements by the year’s end. 

What if insurance companies fail to make good on their word?

“Nothing will happen to them if they don’t comply with voluntary initiatives. It’s a pledge, so it’s hard to say if it will result in actual reforms,” Ms. Tirado of the Medical Group Management Association added. “It never has in the past.”

Ms. Feliciano of HHS did not address what, if any, repercussions there would be for noncompliance.