Prior authorization was supposed to be a check on unnecessary care. In practice, it has become something else entirely: a system that places the burden of proof on the physician who has already examined the patient, reviewed the history, and made a clinical judgment. Spencer Test, DPT, works within that system every day, and the weight of it is not abstract.
The problem is not simply that denials happen. It is that the time required to fight them is time taken directly from patients. Every hour spent on hold with an insurance reviewer, every redundant form, every peer-to-peer call requested by a clinician who has never met the patient, is an hour that cannot be spent delivering the care that has already been deemed necessary by the treating provider.
The prior authorization process has quietly reshaped what it means to practice medicine. Physicians describe a creeping sense that clinical authority has been redistributed, that the decision made in the exam room is now only a first draft, subject to revision by administrators working from coverage criteria rather than clinical context. For many, the demoralization is not dramatic. It accumulates.
What the system rarely accounts for is the patient on the other side of the delay. While paperwork moves through queues and appeals wind through review cycles, patients wait. Some deteriorate. Some give up. The gap between when a physician determines that care is necessary and when the insurer agrees is not a neutral administrative interval. It has consequences that are clinical, not clerical.
The question that hangs over all of it is whether the current structure was designed to protect patients or to outlast them.
