The column below reflects the views of the author, and these opinions are neither endorsed nor supported by WisOpinion.com.
As a practicing dermatologist, my primary goal is to ensure my patients receive the right treatment at the right time. However, in recent years, a growing bureaucratic wall has been built between Wisconsin’s doctors and the people we serve. This wall is known as “prior authorization” – a process originally intended to manage costs that has instead become a leading cause of delayed care and medical complications.
Across our state, physicians are sounding the alarm. According to a 2024 American Medical Association (AMA) survey, a staggering 93% of physicians report that the prior authorization process delays access to necessary care. Even more concerning, 82% of physicians report that these delays at least sometimes lead to patients abandoning their treatment altogether. When a patient walks away from a life-saving medication or a necessary procedure because they are tired of fighting an insurance company, the system has failed.
The human cost is not just anecdotal. Nearly one-third of physicians – 30% — report that prior authorization hurdles have led to a serious adverse event for a patient in their care. This is why the Wisconsin Medical Society, representing more than 10,000 members, is calling on our legislature to support pending legislation to address these issues.
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The Efficiency Illusion
Insurance companies often argue that these “hoops” are necessary for oversight. Yet, data suggest the process is less about medical necessity and more about administrative exhaustion. A 2022 Kaiser Family Foundation analysis found that when a prior authorization denial was actually appealed, the insurance company overturned that denial – either partially or fully – 83.2% of the time.
If the vast majority of denials are ultimately found to be incorrect, why do they happen in the first place? The answer lies in the friction of the process itself. Only one out of every 10 denials is ever appealed because the system is so onerous. Many physicians (67%) report they don’t appeal because they don’t believe it will be successful based on past frustrations, while 53% say their patients simply cannot wait for the health plan to finish its review.
Physicians and their staff are currently trapped on a bureaucratic treadmill. On average, a physician completes 39 prior authorization requests every single week. This consumes roughly 13 hours of clinical time per week – time that could be spent seeing patients. In fact, 40% of physicians now have staff members who work exclusively on navigating these insurance hurdles.
Common-Sense Solutions
Senate Bill 434 does not seek to eliminate prior authorization. Instead, it introduces “common-sense” guardrails to make the process transparent, fair, and predictable for both patients and providers.
The bill establishes clear, mandatory timeframes for insurance company responses: 72 hours for standard cases and 24 hours for urgent medical needs. It also ensures continuity of care; if a patient changes health plans, the new insurer would be required to honor an existing prior authorization for at least 90 days. This prevents “random elimination of care” during vulnerable transitions.
Crucially, the bill addresses who is making these life-altering medical decisions. We believe that if an insurance company is going to issue a medical denial, that denial must be made by a qualified health professional whose scope of practice actually matches the service or drug being requested.
A Path Forward
When prior authorizations are transparent and medically grounded, everyone benefits. Patients receive treatment without harmful delays, health plans maintain oversight, and physicians can focus on what we were trained to do: care for people.
Senate Bill 434 is an invitation to insurers to work alongside physicians in delivering timely, high-quality care. When medical decisions are made efficiently and grounded in clinical expertise, everyone wins. Patients get better faster, physicians spend more time practicing medicine, and insurers avoid the costly downstream effects of delayed or abandoned care. Putting patients over paperwork isn’t just good policy – it’s good business. We are grateful to State Assembly Representative Barb Dittrich and State Senator Rachael Cabral-Guevara for their leadership on this issue. It is time to tear down the bureaucratic barriers and put the health of Wisconsin patients first.
Michael White, MD, is a practicing dermatologist and the President-Elect of the Wisconsin Medical Society.
