Take Action · About this project

Turn a delay into a documented, actionable record.

If your care — or a patient's — was delayed by prior authorization, there are concrete steps you can take to obtain your records, challenge the decision, and add to the public evidence base. This page also explains what this project is, and what it is not.

About this project

Prior Authorization Accountability is an independent, non-commercial project built by a physician to make the cost of prior-authorization delays measurable and discussable. It pairs peer-reviewed dose–response mortality data with insurers' own published decision-time and denial figures to produce transparent, fully sourced estimates of excess mortality risk — always shown with confidence intervals and a complete methodology.

Every number on this site links to a real, citable source. The verified cases and press kit are ready for journalists. The calculator applies published hazard ratios to a delay length you enter; the insurer dashboard shows plans' own reported data; and the evidence page collects the underlying studies and surveys.

What this is — and what it is not

It is: a transparent, sourced estimate of population-level excess mortality risk associated with treatment delay, built on published association data and intended for public accountability and policy discussion.

It is not: medical advice, legal advice, or a claim that any specific insurer "killed" or "caused the death of" any specific person. No estimate here proves causation in an individual case. For decisions about your care, talk to your physician; for decisions about an appeal or claim, consider qualified legal or patient-advocate help.

If your care was delayed

These are general, practical steps — not legal advice. Deadlines and procedures vary by plan and by state, so check the specific instructions on your denial letter and your plan documents.

  1. Request your claim file

    You have a right to the records behind a denial. ProPublica's free Claim File Helper walks you through requesting the full claim file from your insurer — including the internal notes and the criteria used to decide your case.

    Tool: ProPublica Claim File Helper.

  2. File an appeal

    Most denials can be appealed — first an internal appeal with the plan, then, if upheld, an independent external review. The federal consumer guide explains your appeal rights and timelines, including expedited (urgent) appeals when a delay could jeopardize your health.

    Guides: HealthCare.gov — How to appeal an insurance company decision · CMS — External review.

  3. Contact your state insurance commissioner

    State regulators take consumer complaints about coverage denials and delays, and can sometimes intervene. Find your state's department of insurance through the National Association of Insurance Commissioners (NAIC) directory.

    Directory: NAIC — State Insurance Departments.

  4. Tell your physician

    Your treating clinician can document the medical necessity of the delayed care, request a peer-to-peer review with the plan's medical director, and submit a letter supporting your appeal. A clear note in your record about the harm or risk of the delay also strengthens your case.

If a delay is urgent If waiting for a decision could seriously jeopardize your health, ask your plan for an expedited (urgent) appeal — these must be decided far faster than standard appeals. Your physician can request it on your behalf.

For clinicians & advocates

You see the harm of delays before anyone else. Three ways to help build the record:

Contribute

Share your story

Document a delay you witnessed or experienced. Anonymized accounts help turn statistics into accountability.
Estimate

Use the calculator

Translate a specific delay length and indication into a sourced estimate of excess mortality risk, with confidence intervals.
Cite

Cite the evidence

Peer-reviewed and survey sources — AMA, ASTRO, Johns Hopkins, and the Hanna BMJ 2020 meta-analysis — ready to reference.

For policymakers & press

The methodology is open and the estimates are reproducible. We welcome scrutiny, correction, and collaboration.

Methods

Read the full methodology

Every formula, assumption, and source — including the verified hazard-ratio model (HR raised to the power days/28) used throughout.
Data

Explore the insurer dashboard

Plans' own published decision-time and denial data, paired with peer-reviewed delay–mortality estimates and confidence intervals.
A note on framing This project reports estimated excess mortality risk at the population level, based on published association data and shown with full uncertainty. It does not assert that a named insurer caused any individual death. Please reflect that framing when citing these figures.

Contact

For corrections, source submissions, data partnerships, or press inquiries, get in touch. Tips about a delay or denial are welcome — we will not publish identifying details without consent.

Email
press@priorauthaccountability.org

For story submissions, you can also reach us at stories@priorauthaccountability.org.

Share your story Read the methodology

Prior Authorization Accountability is an independent project. It is not affiliated with, endorsed by, or sponsored by any insurer, government agency, or the organizations whose data and surveys it cites.