Prior-Authorization Accountability · United States

Delays have a measurable cost.

When an insurer's prior-authorization process delays cancer treatment, the resulting risk is not abstract. Peer-reviewed data lets us estimate it — transparently, with confidence intervals, and built entirely on published sources.

Open the calculator See the insurer dashboard

~10%

Higher relative risk of death associated with each four-week delay in starting cancer treatment, across common treatment types

Hanna et al., BMJ 2020

The problem in one number

Physicians already report the harm. The data lets us quantify the risk.

Large surveys of practicing clinicians describe what prior-authorization delays do in the exam room. Separately, a peer-reviewed meta-analysis measures how delay translates into mortality risk. This project connects the two — never attributing a specific death to any company, only estimating population-level excess risk from each plan's own published delay data.

29%

of physicians report that prior authorization led to a serious adverse event — such as hospitalization, disability, or death — for a patient in their care

AMA 2024 Prior Authorization Physician Survey

of radiation oncologists say prior authorization has led to or contributed to a patient's death

ASTRO 2024 Prior Authorization Survey

23%

of physicians report prior authorization led to a patient's hospitalization

AMA 2024 Prior Authorization Physician Survey

What this project is — and is not We estimate excess mortality risk based on a plan's own published delay data, shown with 95% confidence intervals and full methodology. We never claim a named company "killed" or "caused N deaths." Estimates are clearly labeled as estimates and are not medical or legal advice.

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Four ways in

Press-ready

Verified Cases

Three fully sourced scenarios plus the Harm Bridge — plan delay → peer-reviewed mortality risk, with copy-paste summaries for reporters.

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Model

The Calculator

Enter a real delay length and indication. Get an estimated excess-mortality multiplier with a 95% confidence interval — using the verified HR^(days/28) formula.

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Data

Insurer Dashboard

Sort indications and published plan delay figures side by side. Every row carries its source and flags intervals that cross 1.0.

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Voices

Share Your Story

Patients and clinicians can document a prior-authorization delay. Submitted with consent, for public accountability and policy discussion.

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How it works

From a published delay to a transparent estimate

Step 1

Insurer's published delay

Start from a plan's own reported decision time or appeal turnaround — the kind of figure required under the federal interoperability and prior-authorization rule (CMS-0057-F).

Reference: CMS-0057-F.

Step 2

Peer-reviewed mortality curve

Map that delay onto the dose-response hazard ratios from a meta-analysis of 34 studies and 1.2 million patients — measured per four weeks of delay, by indication.

Source: Hanna et al., BMJ 2020.

Step 3

Transparent estimate with CI

Apply the same formula to the published lower and upper HR bounds to produce a 95% confidence interval. Where the interval crosses 1.0, the tool says the effect is not distinguishable from zero.

Method: Methodology v0.2.

The evidence

The underlying finding is not in dispute

“Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers.”

— Hanna et al., BMJ 2020 (conclusion). bmj.com

A separate 2025 systematic review of 25 U.S. studies concluded that prior-authorization requirements are associated with measurable patient harm — delays, disease exacerbation, preventable hospitalization, and lower disease-free survival in cancer care.1

Read the full evidence Read the methodology

A note on purpose Prior Authorization Accountability exists for public accountability and policy discussion. It applies published hazard ratios to delay lengths to estimate population-level relative risk — not the cause of any individual death. Every figure carries a real, citable source, and estimates carry the uncertainty of the source studies. Read the full methodology and limitations. This is not medical or legal advice.