Prior Authorization Is Changing: What Employers and Employees Need to Know

If you've ever had an employee say, “My doctor ordered it, but my insurance hasn't approved it yet,” you've probably encountered prior authorization.

And if you've ever tried to help that employee figure out why something hasn't been approved, you know how frustrating the process can be.

The good news? Some of the country's largest health insurers are working to change it.

First—What Is Prior Authorization?

Prior authorization is essentially the insurance company's way of saying:

“Before you receive this service, we need to review it and approve it.”

It can apply to things like:

• MRIs and CT scans

• Certain surgeries and procedures

• Specialty medications

• Physical therapy

• Other higher-cost services

The problem isn't necessarily the idea of reviewing care. The problem is how complicated the process has become.

Different insurance companies can require different forms, documentation, clinical information and submission processes.

That creates more work for providers—and sometimes leaves the employee stuck in the middle waiting for an answer.

What's Changing?

Major health insurers, including Aetna, Cigna, Elevance Health and UnitedHealthcare, are supporting an initiative designed to standardize and simplify prior authorization requirements.

A major implementation milestone is expected January 1, 2027.

The goal is to create more consistency around what information providers need to submit and how prior authorization requests are handled electronically.

Some insurers are already well into the process.

Aetna reports that approximately 88% of its prior authorization volume has been standardized, while UnitedHealthcare and Cigna are working toward standardizing approximately 70% or more of their prior authorization volume by the end of 2026.

Does This Mean Prior Authorization Is Going Away?

No.

And that's an important distinction.

Insurance companies will still require prior authorization for certain services and medications.

What we're hopefully moving toward is a process that is faster, more predictable and easier for providers to navigate.

There are also broader industry efforts underway to reduce the number of services requiring prior authorization altogether.

According to industry reporting, insurers have already reduced prior authorization requirements by approximately 11%—representing roughly 6.5 million fewer prior authorization requests.

That's progress.

But there is still plenty of work to do.

Why This Matters to Employers

Prior authorization might sound like something that happens between an insurance company and a doctor's office.

In reality, employers feel the effects too.

When an employee can't get an MRI approved, can't fill a medication or doesn't understand why a procedure is being delayed, who do they often call?

HR.

And then HR calls the broker.

Administrative problems with healthcare don't stay inside the doctor's office. They affect employees, HR departments, productivity and ultimately the employee's perception of their benefits.

Making prior authorization simpler could mean:

• Faster decisions for employees

• Fewer delays in care

• Less paperwork for healthcare providers

• Fewer frustrated calls to HR

• Less time spent chasing insurance companies for answers

That's a win for everyone.

But There's Still a Problem

Standardizing prior authorization doesn't necessarily mean every authorization will be approved.

Recent data reported by KFF found that health insurers denied approximately 12%–18% of standard prior authorization requests, depending on the insurance market.

Here's the part employers and employees should really pay attention to:

A significant percentage of those denials were overturned when appealed.

Depending on the market, approximately 43%–67% of appealed denials were ultimately reversed.

In other words:

A denial isn't always the end of the conversation.

Employees need to know that.

Benefits Education Matters

This is exactly why employee benefits shouldn't stop after open enrollment.

Employees need to understand how to actually use their health insurance.

That includes knowing:

• When prior authorization may be required

• Who is responsible for submitting it

• How to check its status

• What to do when an authorization is delayed

• What options they have if something is denied

• When to ask their HR department or benefits consultant for help

You can give employees an incredible health plan, but if they don't understand how to navigate it, they're still going to feel like they have bad benefits.

The Bottom Line

The changes being made to prior authorization are encouraging.

Standardization, electronic processing, fewer authorization requirements and faster decisions could eliminate a lot of unnecessary frustration for patients and providers.

But prior authorization isn't disappearing.

That's why employers still need to make sure employees understand their benefits—and have someone they can turn to when the system doesn't work the way it's supposed to.

At S+H Benefit Solutions, that's a major part of what we do.

We don't believe an employer's relationship with their benefits consultant should consist of one renewal meeting a year.

We help employers and their employees understand their benefits, navigate claims and authorization issues, and have an advocate when healthcare gets complicated.

Because choosing the insurance plan is only part of the job.

Helping employees actually use it is where the real work begins.

Source: BenefitsPRO, “Aetna, Cigna, Elevance and UnitedHealth Back New Prior Authorization Standards Push,” April 24, 2026.n is only part of the job.