Months later: Have health insurers delivered on their prior auth promises?

Brandon Edwards: ©Unlock Health

At year-end 2024, driven by tragedy and public outcry, health insurance CEOs pledged reform. Yet, like many similar moments, promises born from pressure rarely pay off. So, we find ourselves past mid-2025, and real action has yet to occur.

Prior auth reform: Promising progress or PR?

In June, more than 50 plans — including UnitedHealthcare, Aetna, CVS, Cigna, and Humana — committed to streamline prior authorization, limit its scope, and standardize electronic workflows by 2027. So we have this straight, Medicare Advantage denials increased 55% and commercial denials increased 20% from 2022 to 2023, yet it takes two years to reform PA? Hmmmm.

The fixes are welcome. Yet providers report no visible relief where it counts, and nowhere near fast enough. More rules, same or longer delays. The challenge: high-volume prior auth denials are now often powered by AI, leading to faster scrutiny and complexity.

Payor scorecards aren’t improving

Physician groups continue to report painful payor performance metrics: low reimbursement, poor communication, rising denial burden, and slow payment cycles. The latest scorecard gives payors a 2.02/5 overall rating. Providers have doubled down on scorecards as strategy tools. They use them to escalate performance shortfalls, demand adjustments at renegotiation, and walk away from friction-heavy relationships.

They also need to be shared with all external audiences, explained, and we need to provide clear calls to action, like preferred plans, better benefit plan design language, and better questions to ask during the sales process.

Providers still don’t trust payors

Trust doesn’t come from better workflows. It comes from consistency, transparency, and accountability — qualities many payors still struggle to demonstrate. Providers just want to know that payors actually care about patients and their care, and that rarely feels like the case.

Payors promise reform yet continue to shift blame for rising costs onto providers. At the same time, they quietly drive administrative burden and deny covered care. The disconnect is familiar. The message feels hollow because the behavior hasn’t changed.

Authenticity requires alignment between what’s said and what’s done. Until payors stop externalizing blame and start owning their role in system-wide friction, provider trust will stay exactly where it is: low.

What providers should be doing now

Accelerate payor performance monitoring. Build transparent scorecards that track denial rates, clean claim rate, first pass resolution, and turnaround across lines. Data drives accountability.

Lean into contract leverage. If a payor is chronically failing in denial management or reimbursements, escalate it — or shift business. Providers are already walking away from bad contracts and bad payor relationships, especially in MA.

Align on patient-first changes. Push compliance efforts around prior authorization reforms. Demand 90-day PA carry-over, electronic real-time approvals, and better appeals clarity.

The louder the promises, the closer we should look. As long as payors continue to posture publicly while blaming providers behind closed doors, it’s on health systems to track what actually changes and hold payors to their own commitments. Authenticity isn’t a sentiment. It’s a signal, and right now, providers aren’t seeing it.

Recently, payors emphasized tech investment, CMS collaboration, and big promises around interoperability. Yet the daily realities — denials, delays, and shifting accountability — haven’t changed. The message may be modernized, but the behavior is not.

Brandon Edwards is the CEO of Unlock Health.