“Prior Authorization” Makes Medicare Patients Sicken and Die

While America’s largest insurance companies rake in tens of billions in profits, they are simultaneously forcing doctors to beg for permission to treat patients—patients who are often elderly, vulnerable, and running out of time.

To make it worse, the federal government actually expanded the use of prior authorization this year.

Billions in profits—built on delays

Health insurance giants call it “prior authorization.” It’s actually a corporate business plan for medical care that delays treatment, worsens illness, and, in too many cases, pushes Medicare patients to death.

The use of prior authorization exploded in the 2010s. With the growth of Medicare Advantage, prior authorization became ubiquitous. The number of required authorizations skyrocketed, especially for routine care.

With the use of AI, giant, vicious healthcare insurance companies have raked in massive profits:

• UnitedHealth Group: $12.1 billion in profit
• The Cigna Group: roughly $6 billion in profit
• Elevance Health: about $5.7 billion in profit
• CVS Health: $1.8 billion in profit
• Humana: $1.2 billion in profit

The Centers for Medicare & Medicaid Services (CMS), a federal agency that regulates prior authorization, shockingly expanded prior authorization requirements on January 1, 2026.

These are corporate giants minting money—while Medicare Advantage patients wait for approvals that may never come. With every delayed MRI, every denied medication, every postponed surgery – that’s more profits booked.

Here’s how prior authorization actually works in real life: A doctor diagnoses a serious condition and orders treatment. The insurer says: Wait. Paperwork is filed. Forms are faxed. Days pass. Weeks pass. And the patient gets worse.

Denials are killing Medicare patients.

According to the American Medical Association, 1 in 4 physicians say prior authorization has led to a serious adverse event—including hospitalization, permanent harm and even death.

Right now, 70 million people in the US are enrolled in Medicare. Medical journals have documented specific examples of patients dying because of prior authorization.

Death from Cancer Progression: The doctors of a West Virginia man recommended histotripsy, which would target a cancerous tumor in his liver. But by the time his insurer approved the treatment, it was too late. He died in September.

Denial of Lifesaving Medications. A Florida man, age 35, died in 2025 after his insurer refused to cover the cancer drug ribociclib. Despite the drug showing promise for his brain tumor treatment, the denial stopped him from receiving the medication in time.

Denial of MRI Imaging Kills Woman. A woman in North Carolina died after her insurer denied a doctor-ordered MRI for severe hip pain, labeling it “medically unnecessary.” The delay, caused by the insurance company’s third-party administrator, prevented the diagnosis of her condition, which turned out to be cancer.

Blood Thinner Delay Exterminates Woman. A patient died in an intensive care unit from a massive blood clot in their lung after their insurance company failed to approve a prescribed blood thinner in time. The delay in authorizing the medication directly contributed to the patient’s death.

Man Dies after Denial of Cancer Drugs and Care. A woman in Chicago with stage 4 colon cancer was denied access to a crucial, lifesaving immunotherapy while their doctor and insurer were entangled in a prior authorization battle.

Up to 80% of patients eventually abandon their physician-recommended treatment due to prior authorization.

Who really makes your medical decisions? It’s often not your doctor. Prior authorization decisions are routinely made by:

• Insurance company employees who have never seen the patient
• Contract physicians in unrelated specialties
• Automated algorithms programmed to cut costs

In other words, corporate spreadsheets are overruling bedside medicine.

Wall Street Runs Healthcare for Seniors

The explosion in prior authorizations has coincided with the growth of Medicare Advantage plans, in which private insurers manage care for seniors. This means Wall Street now obstructs seniors and their doctors. The result?

• More approvals are required for routine care.
• More denials for expensive treatments.
• More delays that older patients cannot afford.

For a 75-year-old with heart disease or cancer, a two-week delay isn’t inconvenient. It’s dangerous.

A system designed to make you give up

The system isn’t just about denying care—it’s about exhausting patients until they quit. Up to 80% of patients abandon recommended treatment due to the complexity and delays of the approval process.

Think about that. Doctors prescribe treatment, insurance companies stall, patients give up, and insurers keep the money.

Physicians now spend 13 to 16 hours a week fighting prior authorization battles instead of treating patients.

That means less time diagnosing illness, less time with patients, More burnout, early retirements, and physician shortages.

The system isn’t just harming patients. It’s driving doctors out of medicine.

Bogus insurance industry defenses

Insurers claim prior authorization prevents unnecessary care and controls costs. But the reality is that delayed care often becomes more expensive emergency care, denials override trained physicians, and bureaucracy replaces medical judgment.

Prior authorization causes widespread harm because denials are profitable.

Reform is coming—slowly.

• Democratic Governor Katie Hobbs: Signed legislation (HB2175) that mandates human oversight for medical insurance denials. The law requires an Arizona-licensed medical director to personally review denials rather than relying solely on AI algorithms.
• Democratic Attorney General Kris Mayes has focused on Medicaid fraud and consumer protection, though her office is empowered to handle appeals of denied claims or authorizations.
• The Arizona Medical Association, led by President Dr. Jason Jameson, has strongly opposed federal prior authorization pilot programs, warning that they jeopardize patient access. 

But the system remains largely intact—and enormously profitable.