Sally Ragab, CEO @ Neunetix.
Every healthcare provider, pharmacist and patient in the U.S. dreads saying or hearing the words, “You’ll need prior authorization for that.” Prior authorization is a bottleneck that slows down care, frustrates staff, and leaves patients waiting.
Prior authorization is a cost-control process that’s in place for a reason. It ensures doctors and other healthcare providers will get reimbursed by insurance companies for costly procedures. Insurance companies want to protect their profit and process fewer patient claims. All these steps are put in place to ensure that a patient truly needs an expensive treatment or medication. But as more guardrails go up, the harder it is for providers to give care or patients to get care.
According to a study by the American Medical Association, prior authorization, or delayed and disrupted care, “has become a predictable and miserable part of the patient experience” that “continues to negatively impact the delivery of necessary medical treatments, jeopardize quality care, and harm patients.” According to the study, more than 90% of physicians reported that prior authorization has a negative impact on patient clinical outcomes. On average, doctors fill out 43 prior authorizations a week, and nearly a quarter of those are denied.
I believe fixing this process isn’t just an operational adjustment—it’s one of the fastest ways we can improve healthcare delivery in the U.S. It’s a simple, focused intervention that can immediately reduce administrative costs, speed up care and improve outcomes—especially for patients with chronic or life-threatening conditions.
Automation Hesitation
When it comes to automating historically manual processes, there is often hesitation. It takes time for providers and patients to trust new technology. When you’ve done something a certain way for a long time, it’s often hard to believe that there’s a better way. If there is, why aren’t we using it? Healthcare bumps against several industry challenges that make changing systems difficult.
• Regulatory and compliance challenges: Healthcare is heavily regulated (e.g., HIPAA, GDPR), and automation solutions must meet strict privacy and security standards, complicating implementation and integration.
• Data interoperability and quality: Fragmented systems and inconsistent data formats make it difficult to create seamless automation across platforms. Additionally, low-quality or incomplete data can hinder the effectiveness of automation tools.
• Workflow integration: Healthcare professionals may resist automation due to concerns about disruption to established workflows, making user acceptance and proper integration a significant barrier.
• Ethical, accuracy and security concerns: Automation in healthcare involves high risks related to patient safety, ethical decision-making and cybersecurity. Ensuring reliable, accurate systems and maintaining data security are critical challenges.
All of these concerns are valid. But it takes time to build trust and implement new ideas. Automation isn’t about replacing staff; it’s about giving providers and staff the tools they need to move faster, smarter and with more confidence.
Time To Purge The Paperwork
We’re at a critical moment in healthcare. Staffing shortages, burnout and rising costs are forcing organizations to rethink how they operate. It’s time to say goodbye to manual processes.
Fixing prior authorization is just the beginning. By automating and streamlining this process, we gain the leverage to optimize others. The same technologies—automation, AI and smart routing—can improve revenue cycle management, inventory control, patient onboarding, treatment plans and insurance claim submissions.
By removing friction from administrative processes, we free up clinical and pharmacy teams to do higher-value work: counseling patients, coordinating care, catching errors and ultimately getting patients the treatment they need, faster.
The best technology doesn’t just automate tasks—it redefines the role of the human. This is how we shift the conversation—from “How do we keep up with paperwork?” to “How do we make sure no patient slips through the cracks?”
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