The 6 worst payers for prior authorization, according to physicians

Three-quarters of physicians who work with UnitedHealthcare say the prior authorization burden in their practice is "high" or "extremely high" — the worst mark of any major commercial health insurer in a new American Medical Association (AMA) survey released Wednesday, and one of six payers a majority of physicians said imposed substantial burden.

The 2025 AMA Prior Authorization Physician Survey polled 1,000 practicing physicians (400 primary care and 600 specialists) in December 2025, asking them to rate the burden imposed by the country's largest commercial insurers. The slides above break down the top six.

A year after the pledge, little has changed

The rankings come almost a year to the day after roughly 60 health insurers, including the six majors, signed a June 23, 2025 pledge to voluntarily streamline prior authorization. Only one in three physicians (33%) said they believe the pledge will produce a meaningful difference for patients and physicians, the AMA survey found. Just 24% said health plan denials based on medical necessity for clinical factors are being reviewed by a licensed and qualified clinician — a commitment that was supposed to be in effect at the time of the pledge. And only 16% of physicians who take part in peer-to-peer reviews said the health plan reviewer often or always has the appropriate qualifications.

"Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises," AMA President Bobby Mukkamala, M.D., said in a statement Wednesday. "When only a third of physicians expect meaningful impact — and so few report that health plan reviewers are appropriately qualified — it highlights a credibility gap that won't be closed with vague or partial measures."

The burden by the numbers

Practices complete an average of 40 prior authorization requests per physician each week and spend 13 hours of physician and staff time managing those requests, the AMA reported.

Nearly one in three physicians (32%) said requests are often or always denied, and three-quarters said denials have increased over the past five years. Ninety-four percent said prior authorization contributes to burnout, and more than one in four (26%) said the process has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment or death.