While commercial insurers often use prior authorization as a way to control costs, it does the opposite for patients undergoing total hip arthroplasty, according to a study presented at the 2025 American Academy of Orthopaedic Surgeons annual meeting in San Diego.
The study found that prior authorizations also led to lower preoperative functional outcome scores and significantly longer wait times before hip surgery, according to a March 10 press release sent to Becker’s.
Approximately 544,000 total hip arthroplasties are performed each year in the U.S., and insurance companies often require patients to undergo physician-documented, conservative therapies, including physical therapy, muscle strengthening exercises, weight reduction, therapeutic injections or anti-inflammatory medications, even in cases where surgeons find these treatments non-beneficial.
The study looked at patients who underwent unilateral, primary hip arthroplasty between January 2020 and December 2022 and were insured by a single commercial payor.
A total of 3,922 commercially insured patients were included, including 2,840 (72.4%) patients whose insurance required prior authorization before THA and 1,082 (27.6%) patients whose insurance did not require prior authorization.
Patients in the prior authorization cohort were more likely to be younger, male, identify as Black, have an increased BMI, and were more likely to undergo surgery as an inpatient. Obtaining prior authorization was found to increase time to surgery by 2.1 days.
Every submission for prior authorization cost between $40 to $50 for private payers and $20 to $30 for surgeons, with each claim taking four to six weeks, on average, to process and pay.
For private payers, more than 90% of prior authorization submissions were ultimately approved.