Last week, a coalition of more than 50 major health insurers signed a pledge at a Washington, D.C. summit to “simplify” prior authorization. Led by Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz along with Senators Bill Cassidy, John Fetterman, Markwayne Mullin, and Roger Marshall, the initiative outlines a series of steps insurers promise to take over the next two years to reduce care delays.
On the surface, this is good news. But the fact that it took a summit in Washington to remind the industry to move away from this outdated practice is a clear sign: the status quo is broken, and iterative changes, implemented over a period of years, aren’t going to be enough. Our health system needs a fundamentally different model.
Let’s be honest. Prior authorization isn’t just a paperwork nuisance. It’s a structural feature of traditional insurance that delays care, frustrates providers, and often leads patients to give up on important treatments altogether. Unfortunately, that’s the point. Patients give up because of the roadblocks and insurers’ margins go up. According to the American Medical Association, 94% of physicians say prior authorizations delay access to care. And nearly 80% of physicians say they’ve had patients abandon treatment because of insurance-driven authorization delays.
The pledge commits insurers to respond to 80% of requests in real-time by 2027. By 2027! We’re asking people to wait two more years for the not-even-radical innovation of… getting their denials faster? It also promises better data sharing and more consistent approvals across plans. These are sensible, necessary goals — but they’re years to come and years overdue.
Here’s the truth: we already know how to build a health insurance model that doesn’t rely on prior authorization at all. A model that doesn’t delay care, doesn’t require doctors to fax over documentation for routine treatments, and doesn’t force patients into a maze of approvals to access care they’re already paying for.
That model exists. And it works by doing something radical: empowering patients and trusting physicians.
In this model, members receive a benefit amount for every medical service — based on local market pricing data — and can use those dollars with any provider they choose. There are no networks. No formularies. No prior authorization. If the service costs less than the covered amount, patients keep a portion of the savings. If it costs more, they simply pay the difference — knowing that they’re making an informed, empowered choice.
This approach shifts the role of insurance from that of a gatekeeper to that of a payer. It aligns incentives between patient, provider, and payer. And it dramatically reduces the need for back-office administration and the adversarial dance that too often defines insurer-provider and insurer-member interactions.
Most importantly, it respects the doctor-patient relationship. It assumes that when a physician recommends a medically necessary MRI or a medication, they aren’t doing it lightly — and they shouldn’t need a second opinion from a computer algorithm to move forward.
The industry’s new pledge is a step in the right direction. But we shouldn’t confuse it with a finish line. Nor should we ignore the deeper truth it reveals: if insurers need to publicly commit to streamlining access to care, it means the current system isn’t working.
We don’t need more promises. We need a new model that makes healthcare accessible, transparent, and timely — without preconditions.
If we want to fix American healthcare, we shouldn’t just patch the old system. We should be willing to build a new one.
Patrick Quigley is the co-founder and CEO of Sidecar Health
