Fact Check: Insurers issued two prior authorization requests for every one beneficiary in 2023.

Fact Check: "Insurers issued two prior authorization requests for every one beneficiary in 2023."

What We Know

The claim that "insurers issued two prior authorization requests for every one beneficiary in 2023" lacks supporting evidence from credible sources. According to the Prior Authorization and Pre-Claim Review Program Stats for Fiscal Year 2023, the data does not indicate a ratio of two requests per beneficiary. Instead, it provides a comprehensive overview of prior authorization processes but does not quantify requests in relation to beneficiaries in such a manner.

Further, the Prior Authorization in Medicaid report indicates that physicians complete an average of 43 prior authorization requests per week, but this statistic does not directly correlate to the number of beneficiaries. The report does not provide a clear ratio of requests to beneficiaries, making the claim difficult to substantiate.

Analysis

The assertion that insurers issued two prior authorization requests for every one beneficiary seems to stem from a misunderstanding or misinterpretation of the data available. The sources reviewed do not support this claim. The CMS report provides statistics on prior authorization but does not break down the requests per beneficiary in a way that would validate the claim.

Moreover, the Medicaid report highlights the workload of physicians rather than the overall number of requests relative to beneficiaries. This indicates that while prior authorization requests are frequent, the claim's specific ratio is not supported by the data.

Additionally, the reliability of the sources is high, as they originate from reputable organizations such as the Centers for Medicare & Medicaid Services (CMS) and the Medicaid and CHIP Payment and Access Commission (MACPAC). These organizations provide data based on extensive research and monitoring of healthcare practices.

Conclusion

Verdict: False
The claim that "insurers issued two prior authorization requests for every one beneficiary in 2023" is false. The available data does not support this assertion, as it lacks the necessary context and specific metrics to validate such a ratio. Instead, the statistics indicate a high volume of requests but do not equate them to the number of beneficiaries in the manner claimed.

Sources

1. Prior Authorization and Pre-Claim Review Program Stats for Fiscal Year 2023
2. Prior Authorization in Medicaid
3. Prior Authorization and Pre-Claim Review Initiatives
4. Prior Authorization and Pre-Claim Review Initiatives
5. Insurers vow to make prior authorization for treatment easier - The Washington Post
6. The Future of Jobs Report 2025 - World Economic Forum
7. Health Equity Analysis of Prior Authorizations 2025
8. Health insurance companies vow changes to prior authorization - USA TODAY