How Insurers Use Prior Authorization to Put Profits Before Promised Care

Introduction to 7 Examples of Profits Over Patients

7 Examples of Profits Over Patients explores how America’s healthcare system has reached a breaking point. Stories like those of Brian Thompson’s tragic death awakened doctors’ and patient frustrations to expose major systemic flaws in the broken American healthcare system. Insurance companies continue to prioritize profits over care, leaving patients to suffer. Prior authorization, intended to manage costs, has transformed into an obstacle for both doctors and patients, often with devastating consequences.

The consequences of this broken system are more often than not placing life-threatening conditions on hold as prior authorizations regularly begin with denial of a legitimate claim. Many of these denials have the greatest impact on seniors depending on Medicare’s disadvantage. Profits before people is a glaring symptom of late-stage capitalism and the politics of greed and self-interest; a Randian debacle.

1. Prior Authorization’s Dire Toll on Patient Health: 7 Examples of Profits Over Patients

Nearly ONE IN FOUR physicians report serious adverse events due to prior authorization delays, according to the American Medical Association (AMA). In one case, a patient with severe immunodeficiency faced denial of critical medication. Insurers argued her infections weren’t yet life-threatening—a shocking misjudgment that delayed her treatment and endangered her health.

Doctors dedicate hours navigating opaque insurer requirements, often to no avail. They describe a grueling battle to secure a common asthma medication for a long-time patient. Multiple calls, obscure forms, and rejected submissions revealed a process seemingly designed to deter care. Such inefficiencies not only harm patients but also burden healthcare providers already stretched thin.

2. A System Designed for Denials: 7 Examples of Profits Over Patients

Insurance practices deliberately confuse. Each insurer imposes unique processes for prior authorizations, forcing physicians to learn “a new language” with every denial. These tactics stall care, frustrate providers, and increase administrative costs. On average, doctors handle 43 prior authorizations weekly, requiring staff solely dedicated to this task. Despite these efforts, delays persist, sometimes for medications costing as little as $31.

3. The Burden of Medicare Advantage Plans

Medicare Advantage plans, covering 99% of enrollees, heavily rely on prior authorizations. This translates to mountains of paperwork, appeals, and stress. For seniors, such barriers mean delayed medications and treatments critical to their well-being. Reforms introduced by Congress and the Centers for Medicare and Medicaid Services aim to ease these burdens, but systemic issues remain unresolved.

7 Examples of Profits Over Patients is an issue that exposes the broken American healthcare system for what it is; a giant corporate rip-off that places profit over patient care. This is particularly problematic for those covered under Medicare disadvantage plans. I am one of those for whom Medicare disadvantage coverage is the only plan available under my retirement pension provider. I borrow the term Medicare disadvantage from Thom Hartmann, a progressive radio host and prolific author exploring the landscape of Late-stage Capitalism and its greed and self-interest at the expense of the rest of us.

4. More Examples of Patient Suffering

Consider the case of an Illinois father denied coverage for a life-saving surgery. The insurer labeled the procedure experimental despite medical evidence supporting its necessity. Months of appeals led to mounting medical debts and deteriorating health. Similarly, a Florida mother’s fight to secure her child’s diabetes supplies revealed the insurer’s disregard for essential care—a delay that risked her child’s life.

I wonder how much of the savings through denial goes into the pockets of the top executives of the Healthcare Insurance Provider. It must certainly be a huge amount as the CEO replacing Brian Thompson at United Healthcare is reported to have a net worth of over $65,000,000.00. How many people were denied coverage and died so the top executives at these cowardly insurance company leaders can build such a net worth?

5. When Insurers Profit from Pain

Insurance companies rake in billions while patients face insurmountable hurdles. A 2023 report revealed that major insurers like UnitedHealthcare and Aetna allocate only a fraction of their revenue to actual patient care. Administrative costs, executive salaries, and shareholder dividends dominate expenditures. The disparity underscores the industry’s profit-driven motives, starkly contrasting with its duty to provide care.

6. State and Federal Reform Efforts

7 Examples of Profits Over Patients is on the front burner of some states that have taken steps to curb insurers’ abuses. Laws in places like California and New York set maximum timeframes for authorizations and streamline paperwork. Federally, Congress reintroduced a bill targeting Medicare Advantage delays. However, these efforts remain patchwork solutions to a national crisis demanding comprehensive reform.

7. The Human Cost of Neglect

The cost of America’s broken system extends beyond finances. Families endure stress, lost time, and diminished quality of life. Doctors voice their anger, knowing they could provide better care if freed from bureaucratic shackles. As one physician noted, “The system functions exactly as designed: to confuse and exhaust, making profits while patients pay the price.”

Reforming America’s healthcare system requires BOLD action. These examples only begin to illuminate the pressing need to prioritize patients over profits. This is especially true for seniors relying on Medicare disadvantage plans that cost too much and deliver too little.

Sources Cited

American Medical Association. (2023). “Prior Authorization: The Physician Perspective.”

Centers for Medicare and Medicaid Services. (2023). “Streamlining Prior Authorization.”

Yaver, M. (2023). Interview on Managed Care Practices.

Suggestions for Further Reading

Wendell Potter, Deadly Spin: A behind-the-scenes look at insurance industry tactics.

Elisabeth Rosenthal, An American Sickness: Examines the U.S. healthcare system’s profit motives.

Atul Gawande, Being Mortal: Explores how healthcare often prioritizes treatment over quality of life.

T.R. Reid, The Healing of America: A global comparison of healthcare systems.

Steven Brill, America’s Bitter Pill: A deep dive into Obamacare and systemic flaws.

Paul Starr, The Social Transformation of American Medicine: Historical context for today’s issues.

Sarah Kliff, “Why Medical Bills Are Killing Us”: A revealing essay on healthcare costs.

Jonathan Cohn, Sick: Personal stories of patients navigating the U.S. system.

Ginna Green and Amy Edgar, Broken Care: Advocacy and solutions for reform.

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