The U.S. healthcare system is experiencing continued drastic changes at all levels, with persistent challenges in communication and financial transparency. Recent survey data underscores the growing frustration among patients and physicians alike, particularly regarding prior authorizations and pricing accessibility.
This survey1 data highlighted a stark reality: over 80% of patients report experiencing confusion or miscommunication between healthcare providers and insurance companies regarding prior authorizations. Moreover, only 19% of patients stated they are usually or always aware of coverage details and costs before undergoing medical procedures. This lack of transparency has far-reaching consequences, affecting patient decision-making, access to care, and financial well-being. Physicians are equally burdened by these inefficiencies. Navigating prior authorizations consumes valuable time, creating an administrative burden that detracts from direct patient care.
The consequences of these inefficiencies go beyond administrative burdens and financial challenges. Delays in securing prior authorizations often result in postponed treatments, worsening health outcomes, and in some cases, avoidable emergency room visits. Patients suffering from chronic conditions or requiring time-sensitive procedures are particularly affected. Without a clear understanding of the costs associated with care, many patients may opt to forgo necessary treatments altogether, leading to long-term complications that further strain the healthcare system and lead to growing frustrations.
The physician perspective: A call for reform
For physicians, the current system is not up to standard. Administrative burdens continue to mount, reducing the time available for patient interactions and clinical decision-making. Studies have shown that physicians spend nearly twice as much time on administrative tasks as they do with direct patient care.2 This imbalance contributes to provider burnout, increased costs, and delayed treatments. Efforts to address these challenges must prioritize efficiency, automation, and patient-centered care. Legislative reforms aimed at reducing the complexity of prior authorizations are a step in the right direction, but they must be complemented by technological advancements that enable real-time access to cost and coverage information.
Physician burnout is also a growing concern within the healthcare industry, and much of it can be attributed to excessive administrative work. The additional stress of navigating insurance requirements, appealing denied claims, and clarifying miscommunications with patients diverts focus away from providing quality care. If these trends continue, we may see an exodus of experienced healthcare providers, further exacerbating the physician shortage and limiting access to care for patients.
Another aspect that requires attention is the impact of financial uncertainty on patient trust. Many patients rely on their healthcare providers to guide them through the complexities of treatment options, insurance policies, and associated costs. When physicians themselves are left in the dark about what procedures are covered and how much they will cost, their ability to effectively counsel patients is significantly hindered. Clearer financial pathways will not only alleviate stress on patients but also strengthen the doctor-patient relationship, fostering a more transparent and supportive healthcare experience.
A path forward
With today’s changing focus, several key initiatives must be prioritized to bridge the communication gap in healthcare. Policy advocacy for prior authorization reform must continue, with physicians, patient advocacy groups, and industry leaders pushing for legislative action that streamlines the process and improves access to care. The healthcare industry needs to also consider investing in improved financial transparency tools that provide real-time cost estimates and coverage details, integrating them into physician workflows for seamless access. Additionally, leveraging AI and automation can significantly reduce the administrative workload associated with prior authorizations. By incorporating machine learning and predictive analytics, healthcare providers can proactively address coverage issues before they lead to delays in care.
In addition to policy reforms and technology-driven solutions, collaboration between insurers and healthcare providers must be strengthened. Insurers need to adopt a more transparent approach, providing clearer guidelines on coverage policies and ensuring that their customer service teams are equipped to answer both physician and patient inquiries in a timely and comprehensive manner. Many issues arise from miscommunications between providers and insurers, leading to unnecessary delays that negatively impact patient care.
Healthcare organizations should also consider implementing more patient-centric financial literacy programs. Educating patients on how to navigate their health insurance plans, understand explanations of benefits, and advocate for themselves within the system can empower them to make informed decisions.
Moreover, continued innovation in digital health solutions will be critical in modernizing the healthcare experience. With the rise of telemedicine and digital patient portals, more patients are engaging with their healthcare providers online. Integrating financial transparency tools within these platforms can offer real-time cost estimates, prior authorization statuses, and clear communication channels between patients, providers, and insurers.
The path to a more efficient and transparent healthcare system requires collaboration across all stakeholders. Physicians, payors, policymakers, and technology providers must align efforts to create a more patient-centric model that prioritizes clarity and accessibility. The survey findings paint a clear picture: patients are struggling with uncertainty, physicians are burdened with administrative inefficiencies, and the overall healthcare experience is suffering as a result.
Addressing these issues is not just about improving operational efficiency—it is about ensuring that every patient receives timely, informed, and accessible care. The time for incremental change has passed; systemic improvements must be the focus of healthcare innovation in 2025 and beyond.’
References
1: careviso Industry Survey- December 2024.
2: Study: Physicians spend nearly twice as much time on EHR/desk work as patients. American Hospital Association | AHA News. September 8, 2016. Accessed February 26, 2025. https://www.aha.org/news/headline/2016-09-08-study-physicians-spend-nearly-twice-much-time-ehrdesk-work-patients.
