In today’s complex healthcare landscape, prior authorization (PA) has become one of the biggest bottlenecks between patients and timely care. While insurers claim that PA helps control costs and ensure medical necessity, the reality is far more complicated. Behind the scenes, payers often leverage opaque rules and hidden policies that create unnecessary delays, increase denials, and ultimately hurt both providers and patients.
According to the American Medical Association (AMA), 93% of physicians report care delays due to prior authorization, and 82% say these delays can lead to patients abandoning treatment altogether. These delays aren’t just frustrating—they’re expensive. The Council for Affordable Quality Healthcare (CAQH) estimates that providers spend $13.29 per manual PA request on average, and practices lose thousands of dollars each month dealing with denials.
At Finnastra, our Prior Authorization Services are designed to simplify this broken process. By understanding the hidden tactics insurers use, we help healthcare organizations navigate the fine print, reduce denials, and accelerate approvals.
Insurance companies rarely make the PA process straightforward. Instead, they use complex systems and vague communication to slow down approvals and, in some cases, reduce payouts. Here are some of the most common tactics:
Insurers frequently update their requirements without clear notification. This leads to:
Example: A multi-specialty clinic in Illinois saw a 22% denial spike in Q2 simply because a major payer updated its PA criteria without sending a formal announcement.
Many denials are based on vague wording in payer contracts or eligibility guidelines.
This is where Finastra’s expertise as a leading Prior Authorization Services Company becomes invaluable—we track every update in real time to prevent these avoidable denials.
Some insurers fail to acknowledge prior authorization submissions in their portals.
Our system integrates insurance verification services and eligibility verification services to confirm payer receipt instantly and keep the process moving.
Research published in Health Affairs reveals that payers intentionally slow the PA process to lower utilization rates. By dragging out approvals, they reduce the likelihood that patients will follow through with treatment.
For example:
Statistic: The AMA reports that 34% of physicians say prior authorization has led to a serious adverse event, such as hospitalization or disability, for their patients.
These tactics don’t just harm patient care—they hit your bottom line.
When you work with a dedicated Prior Authorization Services Company like Finastra, these hidden costs disappear. Our team proactively manages eligibility verification, documentation, and payer communication to ensure clean submissions the first time.
How Finnastra Beats the System
At Finnastra, we’ve built a proven process to outsmart the hurdles insurers set up:
We verify coverage and benefits before PA submission, drastically reducing denials caused by coverage errors.
Our system continuously tracks changes in payer rules, forms, and policies—so your submissions are always accurate and up-to-date.
Using analytics, we identify common denial reasons and prevent them before they happen, improving approval rates by up to 40%.
From initial insurance verification services to final approval, we handle every step, giving your staff more time to focus on patient care.
A multi-location specialty clinic partnered with Finnastra after struggling with 30% denial rates.
These are the kinds of measurable outcomes you can expect when you stop playing by the insurer’s rules and start leveraging Finnastra’s expertise.
If you don’t have clear answers, you may be falling into the very traps insurers set.
As a leading Prior Authorization Services Company, Finnastra ensures your organization stays ahead of payer games.
Don’t let insurers dictate the pace of your practice.
Contact Finnastra today to simplify your prior authorization process, protect your revenue, and deliver the care your patients deserve.
Hidden insurer tactics make the prior authorization process unnecessarily complex. With Finnastra’s integrated Healthcare Prior Authorization Services, practices can reduce denials, speed up approvals, and safeguard both patient care and revenue.
