In a press conference on Monday, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced a landmark agreement with the nation’s largest health insurers to tackle the number one healthcare problem plaguing hundreds of millions of Americans: prior authorization.
Prior authorization is the requirement for doctors and patients to get advance approval from insurance companies BEFORE certain treatments, tests, or procedures are covered. It was meant to control costs, but for 85% of Americans, it’s become a serious barrier to care.
“Doctors like myself are continually struggling with this issue,” Dr. Oz said, explaining how the bureaucratic process not only delays treatment but deeply frustrates both providers and patients.
In 2023 alone, Medicare Advantage (which covers about 32 million people) initially denied 3.2 million prior authorization requests. Dr. Oz made clear these are not just numbers: they represent “individuals who often, in the most vulnerable time in their lives, needed something done and it was denied.”
The burden also falls heavily on physicians. On average, doctors spend 12 hours per week on paperwork, handling about 40 prior authorization cases weekly. Dr. Oz said it contributes to burnout, slows down care, and “erodes public trust in