Prior Authorizations: The Opposite of Health Insurance
“It used to be that if you had health insurance, you were a millionaire.”
When my friend said this, it struck me because I’ve lived the opposite. I grew up in a paycheck-to-paycheck family. When you’re poor there is a constant worry that any upset–a flat tire, broken eyeglasses, a broken arm–will mean a month or two eating beans and rice to keep the lights on. It means not turning on the AC in the humid summers of Florida. It means putting gas in your tank in $5 increments.
Still we had insurance in case of the worst. If our car spontaneously combusted (in Florida, remember) the car insurance would come through. But health insurance hasn’t ever provided a similar sense of security in my memory.
Prior authorizations are the clearest example of how far health insurance has strayed from making you feel like a millionaire.
Isn’t being a millionaire having a deep sense of security that no matter what happens, you’ll have the resources to survive? It doesn’t guarantee happiness or protect you from sadness and loss. But it does provide a cushion to ensure food, shelter, water, health–peace of mind.
Certainly, prior authorizations aren’t the only reason that health insurance feels more like an exploitative necessity than a comforting, worthwhile expense. But they might be the most maddening of the reasons because they are the most antithetical to what insurance should be.
Prior authorizations have risen out of a need for insurance companies to get a handle on expenses. The higher their expenses, the more they must raise premiums. While some premiums are paid by individuals, most are paid by employers who balk at steadily increasing rates year after year.1
Expenses are driven increasingly higher by a stream of regulations limiting other cost control methods such as varying premiums based on individual risk or letting patients choose leaner coverage options. In fact, insurance companies are forced to offer an ever-expanding range of options. Furthermore, the government, looking to avoid further premium increases, has endorsed the use of prior authorizations.2
With increasing government regulations and the institution of prior authorizations, health insurance companies have been forced to become the opposite of what they should be–they elicit a sense of betrayal rather than security.
Personally, thanks to prior authorizations, I’ve gone months without necessary medication.
My story isn’t unique–it doesn’t take much searching to uncover a variety of similar stories. In fact, every few days, I see or hear another example of someone being, at best, inconvenienced and, at worst, medically harmed by their health insurance and the prior authorization scheme.
Today, having health insurance doesn’t make me feel like a millionaire. On the contrary, paying for health insurance makes me feel like a fool. I pay so much money for something to protect my health, only to risk arbitrary denial by prior authorization when it matters most.
Prior authorizations are, literally, the health insurance company telling us that if our medical care gets too expensive it may not be covered. It might, or it might not. It’s a cruel gamble. They’re toying with us! What are we even paying for? Most of us can afford one or two $100 doctor visits a year. But the $30,000 hospital stay that gets denied while they debate medical necessity–that is what we need health insurance for!
Why aren’t we demanding health insurance that meets our needs?
We need coverage for the emergency, the catastrophe, the unexpected, the novel, the expensive! But, with today’s regulations, this type of health insurance–true catastrophic coverage–isn’t available at all.
The more it becomes standard for health insurance to pay for everything, the less it pays for the things we really need. The regulations that have led to this bloated standard inflate the cost of medical care and premiums while simultaneously diminishing the safety net capacity of health insurance. As a result, we all feel health-poor. We are left with a constant worry that in a real emergency, prior authorizations will break us. In this system, we pay for the promise of health coverage only to be denied when we need it the most. We pay to feel the security of a millionaire only to be left with beans and rice.
2024 Employer Health Benefits Survey. KFF. Published. Oct 29, 2024. Accessed June 18, 2025.
How to Pick a Health Insurance Plan. Catastrophic Health Plans. Accessed June 18, 2025.