Prior auth manages who gives up

Prior auth doesn’t just manage utilization.

It manages who gives up.

If you’re a plan sponsor and someone tells you, “Utilization improved,” ask one follow-up:

Did care get delivered?
Or did it get denied, delayed, or abandoned?

Because in practice, prior auth often becomes cost shifting, not care management:

approvals get harder
members abandon care or pay out of pocket
the plan “saves” on that claim
U looks better on a spreadsheet
Then the cost shows up later.
Usually at a higher P.

Here’s the MRI version everyone has seen:

Back pain. Red flags. A doctor wants imaging.

But the plan requires 8 weeks of physical therapy before approving an MRI.

Reasonable in theory (conservative care first).

Nonsensical in practice when:

the member can’t get PT appointments quickly
the pain is severe enough that they stop showing up to work
the underlying issue worsens
they eventually land in the ER, or require a more expensive intervention than they would have with earlier diagnosis
The plan may “save” on the MRI.

But it often buys a higher-cost claim later: ER visit, injections, surgery, extended time off work.

Smart utilization management isn’t fewer approvals.

It’s smarter routing: fast access to the right first step, clear clinical criteria, and plan design that makes early, appropriate care easy.

What’s the worst prior auth requirement you’ve seen backfire and raise total cost later?