It’s almost unbelievable, in 2026, how much of healthcare’s most hated workflow still runs on the fax machine and the phone tree. Prior authorization is where good therapy goes to wait, and the tooling around it is, in a lot of places, genuinely stuck in 1995.
The burden, quantified
The American Medical Association’s late-2024 physician survey is damning. Practices complete an average of 39 prior authorization requests per physician per week. Physicians and their staff spend about 13 hours a week on them. 40% of physicians have staff who work exclusively on prior auth. 93% of physicians say prior auth delays patient care, 82% say it sometimes leads patients to abandon treatment outright, and 94% say it negatively affects clinical outcomes. More than one in four — 29% — said it had caused a serious adverse event for a patient in their care. And 89% say it drives burnout.
Read that again: a process meant to control cost is causing treatment abandonment and adverse events, and burning out the clinicians who have to feed it. In specialty pharmacy, where almost every drug needs a prior auth and the drugs are exactly the high-cost therapies payers scrutinize hardest, this isn’t an edge case. It’s the daily grind.
Why it’s still on the phone
Here’s the dirty secret: a lot of prior authorization still happens by phone and fax because the payer side hasn’t standardized, and the people doing the work have learned that a phone call to the right person sometimes beats the portal. So you get a workflow where staff are on hold with insurers, re-keying clinical details, chasing the prescriber’s office for one missing lab value, and faxing forms back and forth. It’s phone tag with paperwork attached, and it’s measured in days the patient spends untreated.
What voice AI can and can’t do
Let me be precise, because prior auth is a place where overpromising is dangerous. Voice AI is not going to make a medical-necessity determination, and it shouldn’t. What it can do is absorb the enormous communication overhead that surrounds the determination.
A voice agent can call the prescriber’s office to collect the missing documentation that’s stalling a submission. It can call the patient to confirm details the payer requires. It can sit on hold with the payer’s line — the agent doesn’t mind waiting four minutes, or fourteen — and navigate the phone tree to reach a human or check status. It can make the relentless follow-up calls that decide whether an auth moves or rots in a queue, and log every interaction so there’s a clean audit trail. The human specialist stays in the loop for the clinical judgment and the escalations; the agent handles the dialing, waiting, and chasing that currently consume those 13 hours a week.
The compounding effect
Prior auth doesn’t sit alone. It’s tangled up with benefit verification and time-to-therapy — a stuck auth is a patient not starting, which is a refill not happening, which is an adherence metric sliding. Automating the communication layer of prior auth therefore pays off three times: faster starts, recovered staff hours, and fewer patients abandoning treatment in the wait.
For the people writing the check
If you’re a buyer, prior auth is where your most expensive, most credentialed staff are losing hours to hold music. If you’re an investor, it’s one of the largest, most universally despised administrative burdens in all of healthcare — 13 hours per physician per week is an enormous, quantified pool of labor — and the part that’s communication rather than adjudication is squarely automatable with today’s voice AI. You don’t have to solve prior auth to win here. You just have to take the phone and the fax off the humans’ desks. That alone is worth a lot.