Prior Authorization Delays Spine Surgery Without Cost Savings, Study Finds — American Academy of Orthopaedic Surgeons

Event summary

A study presented at the 2026 AAOS Annual Meeting found that prior authorization (PA) for elective spine surgery delayed care without reducing costs.
Insurers denied coverage for 460 out of 7,000 patients (7%) studied, with 81.3% of denials ultimately reversed after an average delay of 15.7 days.
Common reasons for denial included lack of physical therapy documentation (30%), deemed non-medically necessary (26.5%), and no proof of smoking cessation attempts (15%).
The study reviewed cases from January 2021 to December 2024, focusing on patients with degenerative spine disease.

The big picture

As the U.S. healthcare system transitions to value-based care, prior authorization processes are under scrutiny for their impact on cost savings and patient outcomes. The study highlights a strategic anomaly where administrative barriers delay necessary surgeries without achieving the intended financial benefits. With 99% of patients subject to PA rules for high-cost procedures, the findings could influence regulatory frameworks and healthcare provider strategies.

What we're watching

Regulatory Headwinds: Whether AAOS advocacy efforts will lead to policy changes that reduce unnecessary delays in care caused by prior authorization.
Cost Dynamics: The pace at which healthcare systems adopt value-based care models that align with evidence-based treatment principles.
Patient Impact: How prolonged pain and restricted activities due to delayed surgery will affect patient outcomes and overall healthcare costs.