How Health Insurance Prior Authorization Became a Billion-Dollar Gate

Episode 16 of Services Economy with Fexingo digs into prior authorization, the quietly enormous system where insurers approve or deny medical procedures before they happen. Lucas and Luna break down how a process designed to control costs now employs over 500,000 people in the U.S. alone, costs hospitals $31 billion annually in administrative overhead, and can delay cancer care by weeks. They examine a 2025 study from the American Medical Association showing 94% of physicians report care delays linked to prior auth, and the rise of third-party vendors like eviCore and AIM Specialty Health that now gatekeep millions of decisions. The episode also covers state-level reform efforts in Texas and Washington, and the irony that AI-driven prior auth tools are reducing denial rates but adding another opaque layer. A focused look at the middlemen between your doctor and your treatment. #PriorAuthorization #HealthInsurance #HealthcareCosts #AdministrativeBurden #MedicalBilling #eviCore #AIMSpecialtyHealth #AMASurvey #PhysicianBurnout #HealthcareReform #TexasHB2066 #WashingtonSSB5253 #AIPriorAuth #HealthPlanGatekeeping #ServicesEconomy #Economics #FexingoBusiness #BusinessPodcast Keep every episode free: buymeacoffee.com/fexingo