How Prior Authorization in Healthcare Began
Prior authorizations emerged in the 1970s and 1980s as insurers and payers sought ways to control healthcare costs and ensure appropriate care. As new diagnostic procedures, expensive therapies, and specialty medications entered the market, payers wanted a way to confirm that these services were:
- Medically necessary
- Cost-effective
- Safe and appropriate for the patient’s condition
PA became a gatekeeping tool—a way for insurance companies to review and approve certain services before they were delivered.
This review process was especially important for high-cost drugs, surgeries, or services that had lower-value alternatives—or that could be dangerous if used inappropriately.
The Original Intent: A System for Accountability
In theory, PA was meant to:
- Promote evidence-based care
- Curb unnecessary spending
- Encourage the use of cost-effective treatment alternatives
- Ensure high-value care reaches the right patients
The Shift: From Oversight to Overload
Over time, the PA process grew more complex and opaque:
- Different payers, different rules: Each insurer developed its own criteria, forms, and portals.
- Volume explosion: As more medications and services required authorization, the workload multiplied.
- Manual processes: Fax machines, phone calls, and siloed systems became the norm.
- Delays in care: Patients often waited days or weeks for approvals—sometimes with serious health consequences.
What began as a safeguard turned into an obstacle. A 2022 AMA survey found that:
- 94% of physicians reported care delays due to PA.
- 33% said PA led to a serious adverse event for a patient in their care.
The Role of Technology: Untapped for Too Long
Despite the digital revolution in healthcare, PA remained largely manual. Most systems still require:
- Redundant data entry
- Repeated faxing and calling
- Tracking approvals across multiple payer portals
This disconnect is what inspired the creation of Karova Health—a platform that reimagines prior authorizations using automation, AI, and empathy. Learn how Karova’s AI-powered solution compares to outdated, manual prior authorization workflows.
Why We’re Here: Karova’s Vision for the Future
We believe that prior authorization doesn’t need to be broken—it just needs to evolve.
At Karova, we’ve built a solution that:
- Analyzes clinical records automatically
- Fills out payer-specific PA forms
- Submits requests in real time
- Prevents delays before they happen
Our goal is to return PA to its original purpose: a mechanism that supports quality care, not one that blocks it.
Final Thought
Prior authorization was meant to be a tool for better care. It shouldn’t be a reason patients suffer or providers burn out.
It’s time to make the system smarter, faster, and more humane.
At Karova Health, we’re doing just that. Want to see how Karova transforms prior authorization in healthcare? Request a demo and discover a faster, simpler future.
