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Can AI Finally Simplify the Prior Authorization Process?

Healthcare professionals across specialties are expressing mounting frustration with the prior authorization process. One new primary care physician captured the collective exasperation perfectly: “As a new PCP, calling insurance companies to get medications covered is absolutely ridiculous. It feels like an episode of south park. you enter tax ID, NPI, member ID, date of birth, name, your name, your job. Then they transfer you to someone else who asks the same information.”

The discussion reveals that prior authorization has become one of the most time-consuming, financially draining aspects of modern medical practice—and healthcare professionals are actively seeking alternatives.

The Prior Authorization Time Drain

Healthcare professionals consistently report that prior authorization calls consume 20-30 minutes of physician time per medication approval. As one practitioner described: “Then they repeat this for 20-30 minutes until the call just sort of ends.”

The time investment extends beyond just phone calls. A hospitalist shared: “I get the pleasure of the follow up call where I simply read out admission VS that the reviewer should have, in order to ‘justify the admission’.”

The absurdity reached new heights in one case: “I had to do a peer to peer once because they refused to pay for a bedside commode for a pt. Had to schedule a time 24 hours in advance, stop in the middle of rounds, and then spend 10 minutes on hold waiting for them to join.”

Working as Intended: The Soft Deterrent Strategy

Healthcare professionals have identified the underlying purpose of these byzantine processes. Forum discussions reveal a clear consensus: “Working as intended” and “Yep, soft deterrent. It sucks.”

The strategy is transparent to those on the front lines. One physician explained: “They know exactly what they’re doing. Advertise Cadillac insurance that pays for everything, nickel and dime for every single down to the minute detail.”

The Billing Gap: Unbilled Administrative Work

Healthcare professionals recognize a fundamental inequity in the system. One physician articulated what many were thinking: “It’s too bad we can’t bill for the time these take. Then perhaps they’d be reserved for the truly expensive and limited meds.”

The comparison to other professions sparked discussion: “If lawyers can charge per word sent on an email, we should be able charge for a service we are providing as well.”

One practitioner posed the question directly: “Imagine charging by consult note length. Neurology, rheumatology, neuropsychiatry an infectious disease would suddenly become the highest paid, maybe even billionaires.”

The frustration centers on uncompensated work. As one physician noted: “There’s so much time that we spend that’s unbilled.”

United Healthcare: The Worst Offender

Multiple healthcare professionals identified United Healthcare as particularly problematic. One physician stated: “They are by far the WORST when it comes to denials/P2Ps for inpatient admissions.”

The inefficiency compounds: “The denial is always done initially by some RN who basically has no basic understanding of medical standard of care. I recently had to do a P2P for acute pancreatitis that ended up requiring ERCP and pancreatic duct stenting. This was denied and on the P2P call I learn that they didn’t even know the patient had an ERCP.”

Healthcare professionals have confirmed that insurance companies have EMR access: “I have asked my case managers about this issue repeatedly and they have confirmed that UHC, and basically every insurance company, has access to our EMR, so there shouldn’t be a logistical reason they can’t pull up this shit themselves, but no, they need me to read out my notes to them over the phone to overturn the denial.”

Peer-to-Peer Call Manipulation

Another shared: “I had one recently where they gave me three times, each of which were 2 hour blocks on different days. Was told that they could call me during any of those blocks but they would call only once and if they didn’t get me it would be automatically denied.”

The absurdity continues: “I’m not sure if they expected me to just not see any patients for six hours waiting for the call? In any event, they never called at all and approved it anyway.”

The documentation game favors insurance companies: “When they send the denial to the patient and you, they of course list the time when they called your clinic and even they attempted to reach you, and they never list the times when you tried to call and reach them, making it look like you never returned the call altogether.”

Technology Solutions: Limited Success

Healthcare professionals have experimented with digital solutions. CoverMyMeds receives frequent mentions: “Have you tried the website; covermymeds.com? Streamlines the prior auth process.”

However, limitations exist: “This works well for private insurance but I do PAs pretty routinely for Medicaid in two states and I still have to print and hand write out the necessary forms.”

One physician confirmed: “CoverMyMeds is your best friend in this situation. I don’t have to talk to anyone 98% of the time. Usually get an instant determination or within a day or two.”

The consensus remains that technology helps but doesn’t eliminate the fundamental problem: “The questions are just as ridiculous but there is no time wasted on hold.”

Virtual Prior Authorization Specialists: The Alternative Healthcare Professionals Choose

While prior authorization processes continue to waste physician time and drain practice resources, healthcare professionals are discovering that specialized virtual assistants provide a practical solution to administrative burden.

The cost comparison is significant. Virtual prior authorization specialists starting at $9.50/hour cost under $2,000 monthly for full-time dedicated support, compared to local administrative staff requiring $4,500 base salary plus payroll costs and benefits totaling up to $6,000 monthly.

HIPAA, SOC 2, and ISO 27001 compliance provides enterprise-level security for patient data, with fully managed compliance oversight that healthcare practices require.

Virtual specialists manage the entire prior authorization workflow: completing forms, navigating payer portals, conducting follow-ups, and handling appeals. They can schedule and attend peer-to-peer calls, document all interactions, and track approval status across multiple insurance companies and patients.

AI-Enhanced Prior Authorization: The Human Oversight Reality

Some practices are exploring AI tools for prior authorization management, but healthcare professionals emphasize a critical reality: AI tools require dedicated human oversight and management.

As one practitioner noted about broader AI healthcare applications: “The AI bundles they offer are more AI-assisted technology. 2025 is definitely the year of AI products but we aren’t at 100% AI automated, meaning you will likely still need someone to babysit the AI and act on the ‘problems’ it discovers.”

Smart practices combine AI automation for routine form completion and data entry with virtual specialists who handle implementation, monitoring, system optimization, and complex cases that require human judgment.

This AI-enhanced approach addresses the core problem healthcare professionals identify: reclaiming physician time for clinical care rather than administrative busy work.

The Measurable Impact on Patient Care

Research confirms what healthcare professionals report anecdotally. Studies demonstrate that prior authorization processes hurt patients in measurable ways, creating treatment delays, medication non-adherence, and adverse health outcomes.

For healthcare professionals already stretched thin, the administrative burden compounds. One physician summed up the sentiment: “It won’t matter. There’s only so many times per day you can be on hold for 20-30 minutes. You also have to see clinic patients and live life outside of work with perhaps a family and children that needs attention.”

The solution healthcare professionals are choosing involves delegation: “The prior auth (aside from being eliminated) needs to be delegated to another team member not you.”

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Stop Wasting 20-30 Minutes Per Prior Auth Call

Healthcare professionals report that prior authorization calls consume physician time that should be spent on patient care. Instead of repeatedly entering “tax ID, NPI, member ID, date of birth, name, your name, your job” across multiple transfers, practices are choosing virtual prior authorization specialists who handle the entire process.

30-Day Prior Authorization Management Trial

✓ Virtual Prior Authorization Specialists – Handle forms, payer portals, follow-ups, and peer-to-peer calls without consuming physician time

✓ Healthcare-Trained Professionals – Medical Doctors, Nurses, and PharmDs who understand clinical workflows and insurance requirements

✓ Transparent Fixed Pricing – Starting at $9.50/hour, under $2,000 monthly vs $4,500+ base salary plus payroll costs and benefits totaling up to $6,000 monthly

No more 20-30 minute holds. No more repeating information across multiple transfers. No more missing scheduled peer-to-peer calls.

Reclaim physician time for patient care. Join practices that delegated prior authorization to specialized virtual teams.

HIPAA-compliant. Healthcare-specialized. Starting at $9.50/hour, under $2,000 monthly.

What Did We Learn?

1. Prior authorizations remain a major bottleneck in healthcare.
   Manual reviews, inconsistent payer rules, and excessive paperwork delay care, frustrate providers, and drain administrative time.

2. AI has real potential to transform the process.
   Artificial Intelligence can automate form submission, verify patient data, and predict authorization outcomes—reducing human workload and turnaround time.

3. Integration is key to success.
   For AI to work effectively, it must integrate seamlessly with EHR systems, payer databases, and clinical workflows, ensuring real-time data sharing and accuracy.

4. Human oversight is still essential.
   While AI can handle repetitive tasks, final approvals, medical judgment, and exception handling still require clinical or administrative review.

5. Compliance and transparency matter.
   AI tools must comply with HIPAA and payer policies while maintaining clear audit trails for accountability and regulatory adherence.

6. The future of prior authorization is hybrid.
   The best outcomes will come from combining AI efficiency with human expertise—automating where possible and intervening where necessary.

What people are Asking?

1. What is prior authorization in healthcare?
Prior authorization is the process where healthcare providers must get approval from insurance companies before delivering certain treatments, tests, or medications.

2. Why is the prior authorization process so complex?
It involves multiple payers, manual forms, and frequent rule changes — all of which create delays, denials, and administrative burden for healthcare staff.

3. How can AI help simplify prior authorizations?
AI can automate data entry, verify coverage, predict approval outcomes, and reduce manual errors — saving time and improving accuracy for providers.

4. Does AI replace human staff in prior authorizations?
No. AI supports human teams by handling repetitive tasks and flagging issues early, while staff focus on patient care and complex approval cases.

5. Can AI reduce prior authorization denials?
Yes. By validating claims and identifying missing information before submission, AI helps prevent avoidable denials and speeds up approvals.

6. Are AI-powered authorization tools HIPAA compliant?
Reputable solutions are designed to meet HIPAA standards, ensuring patient data security, confidentiality, and compliance with payer requirements.

7. What’s the future of AI in prior authorization?
AI will increasingly integrate with EHR systems and payer APIs, moving the process toward real-time, automated approvals across the healthcare industry.

Disclaimer

For informational purposes only; not applicable to specific situations.
For tailored support and professional services,

please contact Staffingly, Inc. at (800) 489-5877
Email : support@staffingly.com.

About This Blog : This Blog is brought to you by Staffingly, Inc., a trusted name in healthcare outsourcing. The team of skilled healthcare specialists and content creators is dedicated to improving the quality and efficiency of healthcare services. The team passionate about sharing knowledge through insightful articles, blogs, and other educational resources.