‘Delay and deny’ insurance practices hinder health care, CT patients, doctors say

Hartford Courant – Monday, June 22, 2026
By Livi Stanford

When Matt Conway tore his bicep delivering a table recently, there were numerous barriers to getting it fixed.

First, “a month of navigating structural insurance blockades,” then just 15 minutes for the orthopedic surgeon to order an MRI “STAT” to proceed to surgery. But Conway couldn’t schedule the MRI that day because prior authorization was required by the insurance company.

He persisted in what many patients would not: “37 hours of relentless phone calls just to get my insurance company to approve my surgeon’s urgent “STAT” order.”

Finally, he got the MRI but the delay pushed the test into the late hours of Friday, meaning the results couldn’t be read until days later.

“A 37-hour insurance delay easily turns into a 4-day medical delay. When you are facing a closing window for surgery, every single hour counts,” Conway, a former health care strategist who now runs The RiseUP Group Inc. in Hartford, said in a post chronicling the ordeal.

While he waited, his bicep retracted, making the surgery more complicated and risky, Conway said.

“Doctors should be allowed to practice medicine, and patients shouldn’t have to fight a bureaucracy just to follow their surgeon’s urgent orders,” he said.

He formed the CT Patient & Provider Protection Coalition to challenge “delay and deny insurance tactics” he said are harming patients and burning out physicians.

Local doctors, lawmakers, patients and the American Medical Association, say that the number of prior authorizations and claim denials that insurance companies issue is increasing, leading to delays in care and countless hours of doctors’ time lost in advocating for their patients to receive the tests, prescriptions or procedures they prescribed.

‘Automatic denials that are roadblocks for patients to access care’

Sen. Matt Lesser, a Middletown Democrat, who also serves on the state’s Insurance and Real Estate Committee, said he hears almost every day from people in the community who have had health insurance claims denied including denial of specific treatments for cancer, procedures and hysterectomies.

“What we are hearing is that there’s an increasing use of technology to automate the process including the use of AI — automatic denials that are roadblocks for patients to access care.”

Sen. Saud Anwar, co-chair of the state’s Public Health Committee, said it “is absolutely outrageous what the insurance companies are doing to the patients.

“Between prior authorizations for the most basic medications, critical tests and procedures, they are creating hoops and difficulties and frankly they are abusing their position and some of the federal laws that have given them protection,” he said. “They’re using that in a manner which is now hurting the citizens of the state of Connecticut and basically killing the field of medicine altogether because people learn medicine to provide care, not to be on the phone holding to talk to somebody who’s not even qualified to have the conversation on the medical wellbeing of the patient.”

Lesser said sometimes it is not even a real denial but an automated one that can be appealed.

“But meanwhile people are freaking out,” he said. “They have been told that they can’t get this essential procedure that they have been told that they need and so of course their alarm is sky high and then there are other people who can’t get the treatment because it is a real denial.”

In the midst of claim denials and prior authorizations, the health industry is also contending with an increase in hospital and pharmaceutical costs.

The Connecticut Insurance Department Report Card on health insurance carriers in the state reports that the insurance companies saved $187 million by requiring prior authorizations in 2024. The report further says that 13% of Cigna’s benefits require prior authorization compared to 32% for ConnectiCare, 38% for United HealthCare and 4% for Anthem.

The Courant sent questions to Connecticut insurance companies Anthem, Cigna, ConnectiCare and United HealthCare, inquiring how many claims each has denied and how many prior authorizations it issued in the last year. None responded to the Courant’s questions concerning its data.

An Anthem Blue Cross Blue Shield spokesperson did not answer the Courant’s questions but instead asked that questions be directed to Susan Halpin, executive director of the Connecticut Association of Health Plans, who is listed as a lobbyist for the association.

Halpin said in an email, “Connecticut health plans process millions of claims each year, yet prior authorization applies to only a subset of healthcare services.

“According to the Connecticut Insurance Department’s 2025 Consumer Report Card, which reports 2024 data, the majority of covered healthcare services were delivered without prior authorization review,” she said. “Depending on the carrier and product, between 62% and 97% of covered services were not subject to prior authorization requirements at all.

Halpin said “health plans have worked in recent years to further reduce administrative burden by eliminating prior authorization requirements for many routine and lower-risk services, expanding electronic prior authorization capabilities, implementing real-time decision tools, and creating programs that allow qualified providers to receive expedited approvals or exemptions from certain requirements.”

A spokesperson for the Cigna Group said the insurance group is “taking steps to reduce the burden prior authorization can create for both patients and physicians.

“In 2025, fewer than 6 percent of our customers had prior authorization requirements and we’re taking steps to reduce that number by year-end,” the spokesperson said. “This year alone, we eliminated these requirements on about 15% of services, tests and procedures. The majority of requests are handled electronically, often in real time, and most are approved within one day.”

United HealthCare referred the Courant to its website on its claim approval rate and why a prior authorization is needed.

“At UnitedHealthcare, we approve and pay 90% of claims shortly after they’re submitted,” the website said. “The remaining 10% go through an additional review process.”

‘They are making it impossible to practice medicine’

Dr Mariam Hakeem-Zargar, an orthopedic surgeon with a small independent practice in Torrington, said dealing with claim denials and prior authorizations is now taking up 20 to 30% of her staff’s time.

“Time that they don’t have to answer phone calls for patients, help patients do scheduling,” she said. “They are just killing us with paperwork. They’re making it impossible to practice medicine. They are not in the business of care.”

She said Medicare Advantage plans in order to make a profit “just deny care or make it hard to get care by instituting these prior authorization policies.

“Every time we want to prescribe a medication, if it’s in their list of expensive things, that means prior authorization,” she said. “Then you submit a form. Wait for an answer. Denied.”

Dr. Khuram Ghumman, associate dean for strategic partnerships at the Frank H. Netter MD School of Medicine at Quinnipiac University and a practicing physician, said “unwanted and unintended consequences” of insurance company policies “can sometimes lead to delayed care and sometimes no care.”

He said he encounters claim denials often in his practice.

“I think they value profit over patients,” he said.

A pledge to fix prior authorizations

The American Medical Association reported last month that after “successful engagement from the Trump administration to address concerns from patients and physicians roughly 60 health insurers pledged to fix prior authorization requirements via efforts through 2027.”

The AMA surveyed 1,000 physicians to assess their views on the pledge.

“Findings from the survey show that only one in three physicians (33%) believe the latest insurer pledge will make a meaningful difference,” said the AMA in a release.

The survey also found that more than 1 in 4 physicians report that prior authorization has led to a serious, adverse event for a patient in their care.

Dr. Bobby Mukkamala, a board certified head and neck surgeon and past president of the American Medical Association, said across the country, “every insurance company seems to use prior authorization as a tool in their opinion.

“But we see it as a barrier in our opinion,” he told the Courant. “It’s the vast majority of patients that have this concern that prevents them from getting the right thing or the best thing and instead sometimes relying on second best versus just giving up, and both obviously are bad.”

He recalled a patient with tonsil cancer who needed a PET scan that took a month to get approved.

“And during that month, sure enough a lymph node in the neck pops up,” he said. “And that wasn’t there a month before.”

Patient and Provider Coalition

Conway’s Patient and Provider Patient Coalition includes a group of patients, healthcare workers and community organizations “fighting to make health insurance actually work,” according to information on the coalition.

“It impacts every single person whether you are poor, middle class or have great insurance from your employer,” Conway said.

He said other patients have shared many stories of challenges with prior authorizations and claim denials.

“Another buddy of mine, his dad had a severe stroke,” he said, and the insurance company denied coverage at the rehab center.

Instead, the man was sent to a long-term care facility that does not have any specialty services for those who have had a stroke, Conway said.

“He is still not recovered at all,” he said.

Kim Adamski’s husband, takes a biologic TNF inhibitor, a specialty medicine keeping him in remission from Crohn’s. But his insurance company denied coverage for the original medication and paying just 50% of the cost of a generic drug.

“There are assistance programs but they are unreliable and often require hours per month on the phone with our insurer,” Adamski said. “This has caused him to be late on his medication for the past four months.”

Reducing prior authorizations in state health insurance

State Comptroller Sean Scanlon said it “used to be that we lived in a healthcare system where you got sick, you went to the doctor and the doctor who is a professional decides the best course of care for you is and you get that care and your insurance company pays for it.

“We’ve increasingly become a society in which the insurers are playing doctor and intervening in your healthcare decisions between you and your doctor,” he said. “That’s a bad development in our healthcare system.”

Scanlon said when he went to renegotiate the contract for the first time regarding the state health insurance plan, “we insisted on dropping the number of prior authorizations required.

“We said ‘if you want to do business with the state, you’ve got to do less prior authorizations,’” he said.

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The change to the state’s health insurance plan, which serves 270,000 state employees including 60,000 retirees, has resulted in a lower denial rate of 6.3%, approximately half that of the commercial payer industry.

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