Patients should not have to wait weeks for care their doctors already know they need. Yet every day, prior authorization allows insurance companies to delay treatment, overrule clinical judgment, and drain time from the exam room. The result is not better medicine. It is burnout for physicians, frustration for patients, and a system that too often rewards delay over care.
No one chooses health insurance expecting to hand medical decisions to an insurer. But that is exactly what prior authorization does. After 38 years, practicing family medicine in a rural community, I have watched bureaucracy overrule bedside judgment in real time. The consequences are not abstract. When days matter, “reviews” that drag on for weeks — or months — can turn treatable problems into tragedies.
I went into medicine to serve people, not paperwork. I still love caring for patients. But now I spend roughly two days a week on administrative churn just to keep my clinic functioning. That is not “efficiency.” It is a hostile takeover — one that fuels burnout and steals time from sick people. Medicine has become a high-stakes game of “Simon Says”: check the right box, use the right phrase, submit the right form — or get denied. The patient, of course, just waits.
Practicing medicine is rarely the problem. Bureaucracy is. Nothing is more dangerous — or more insulting — than letting anonymous reviewers overrule the clinician who examined the patient and built the plan. Prior authorization was sold as cost control. It has become a profit center. Insurance was supposed to protect families from financial ruin. Too often, it now functions as a paid obstacle course, deciding what you can get, when you can get it, and where you are allowed to go.
That is prior authorization: rationing by delay, dressed up as “review.” The moral hazard is obvious. If I make the wrong call and a patient is harmed, I can be sued, reported, and lose my license. But when an insurer delays or denies care, it saves money immediately while appeals drag on. If the patient worsens in the meantime, the people who designed the delay often face little or no accountability. Even when a denial is reversed, the harm cannot always be undone.
If prior authorization reliably lowered costs without hurting patients, we could at least have an honest debate. It does not. It creates more bureaucracy, wastes staff time, and delays care — only for many requests to be approved anyway. In other words, everyone pays the price for a process that often ends where it should have started: with the clinical decision made in the exam room. This is not a safety check. It is a tollbooth.
What would real reform look like? Start by ending prior authorization for routine, evidence-based care in Medicare Advantage and in plans sold on the federal exchanges. For everything else, impose hard deadlines — hours or a day, not weeks — require named reviewers on denials, and create real penalties when delay causes harm. Publish approval, denial, and reversal rates plan by plan so the public can see who is blocking care. Then do the simplest thing of all: get insurers out of the exam room and put patients back at the center of medicine.
North Carolina has a chance to lead. House Bill 434 which includes prior-authorization reforms, passed the House in 2025 and was bottled up in the Senate where the measure remained unresolved as of 2026. That should not be the end of the story. Lawmakers should finish the job and make clear that medical decisions belong to clinicians and patients — not to insurers that profit when care is delayed.
North Carolina already struggles to recruit and keep doctors. We should not be burning them out with a process that delays treatment, drives up frustration, and puts patients at risk. We currently have a process where patients are being harmed, Doctors are being diverted from care to crap tasks. Its time to rid ourselves of a process that benefits no one except the insurance companies.