The Hidden Insurance Scam Hurting Millions

TL;DR

Prior authorization — insurers requiring pre-approval before covering care — is the #1 healthcare burden for Americans, with denials often reversed on appeal yet rarely challenged.

Key Points

• 1.Prior authorization is the single biggest healthcare burden for Americans. A KFF poll found ~70% of insured adults find the process burdensome, ranking above billing confusion, appointment access, and finding in-network providers — consistent across employer, Medicaid, Democrat, Republican, and independent groups.
• 2.Medicare Advantage insurers denied over 4 million of 53 million prior authorization requests in 2020. Yet only ~11% of denials were appealed, leaving millions potentially without care simply because the appeals process was too difficult to navigate.
• 3.Over 80% of appealed Medicare Advantage denials were overturned. Senator Jon Ossoff argues this statistic reveals the denial itself is the business model — insurers bank on sick patients lacking the energy and resources to fight back against a powerful industry.
• 4.Physicians bear a massive administrative toll from prior authorizations. A 2024 AMA survey found doctors handle an average of 39 prior authorizations per week, consuming 13 hours of work, with 93% reporting delays to necessary care and 82% saying patients abandon needed treatments.
• 5.Eric Tennant, a West Virginia cancer patient, died after his insurer repeatedly denied a noninvasive ultrasound tumor treatment as 'experimental.' The insurer reversed its decision only after media coverage, but by then Tennant was no longer a surgical candidate; his death directly prompted a unanimous West Virginia state law protecting treatment continuity.
• 6.Senator Ossoff has opened a Senate investigation into insurance claim denials and sent formal questions to CMS administrator Dr. Mehmet Oz. He is seeking data on denial rates, legitimacy, and appeals outcomes per insurer, warning the Trump administration that defending insurers over patients will carry a heavy electoral cost.