The Payer Pledge Scorecard: Promises vs What Practices Actually See

A pledge is a promise, and promises about prior authorization have a history. In 2025, roughly 60 insurers made a widely publicized commitment to fix the process. A year and a half later, we can compare what they promised against what physicians report actually experiencing, and the honest scorecard is not flattering.

What was actually pledged

In June 2025, after federal engagement, roughly 60 health insurers, including the largest national carriers, voluntarily committed to a set of six prior authorization reforms with deadlines staggered from 2025 through 2027 AMA pledge survey, 2026. The commitments covered the main pain points: reducing the scope of services that require prior authorization, honoring existing authorizations when a patient changes plans, standardizing electronic prior authorization, ensuring medical-necessity denials are reviewed by a qualified clinician, improving transparency, and delivering faster real-time decisions. On paper, it addressed nearly every physician complaint. The question is not whether the promises were the right ones, they were, but whether they have translated into what practices actually experience. That is what a scorecard measures.

Here are the six commitments and their timelines.

The scorecard

Here is the pledge, promise by promise, against what physicians report in the AMA's survey of 1,000 practicing physicians.

Read down the right column and the pattern is consistent: the promises are broad, the reported reality is thin. Notably, the one commitment that was already in effect at the time of the pledge, qualified-clinician review of medical-necessity denials, is seen consistently by only a quarter of physicians, which does little to build confidence in the commitments still pending. The peer-to-peer numbers are covered in depth in the peer-to-peer guide, and the fuller burden data in the prior auth statistics.

Why physicians are skeptical

The skepticism is not reflexive negativity; it is earned. Three things drive it. First, the pledge is voluntary, with no enforcement mechanism, so nothing compels an insurer that falls short. Second, it echoes a nearly identical 2018 pledge that underdelivered, which is why the AMA president described physician trust in voluntary insurer commitments as "deeply eroded after years of unfulfilled promises." Third, early experience has not moved the needle: few physicians report seeing even the already-effective commitments fully implemented, and the reported numbers on qualified review remain low. When you have been promised the same fix before and watched it fade, discounting the new version is not cynicism, it is pattern recognition. That is the honest reason only a third of physicians expect meaningful impact, and it is a fair basis for how a practice should plan. Where reform has and has not landed across the year is traced in the 2026 review.

Pledge vs enforceable rule

To be evenhanded, not all prior auth reform is equally toothless, and the distinction matters. The voluntary pledge covers a broad set of insurers but carries no enforcement, so its results depend entirely on goodwill. The CMS-0057-F rule, by contrast, is an enforceable federal regulation, it legally binds the plans it covers to specific timeframes and electronic standards, but its scope is narrow, reaching only Medicare Advantage, Medicaid, CHIP, and exchange plans, covered in the CMS rule breakdown. So the reform landscape has one instrument with broad scope and no teeth, and another with real teeth and limited scope, and neither fully addresses the commercial prior authorization that burdens most practices. Holding both in view is the accurate picture: genuine, enforceable progress on a slice of your payers, and broad but unenforceable promises on the rest. The full evenhanded account of the reform effort is in the reform breakdown.

What did move, in fairness

To be fair rather than reflexively negative, some things did shift, and an honest scorecard notes them. On the enforceable side, the CMS-regulated plans did begin operating under faster decision timeframes and denial-reason requirements, real, if narrow, progress. On the voluntary side, some insurers did announce reductions in the specific services requiring prior authorization, and a few reported early steps toward electronic and faster review. The problem is not that nothing happened; it is that what happened has been partial, uneven across insurers, and not yet visible in physicians' day-to-day experience, which is why the reported numbers stay low even as some announcements are genuine. It is also early: several pledge deadlines run through 2027, so the final verdict is not fully in. The evenhanded read, then, is neither "reform is a sham" nor "reform is working," but "some real movement, mostly on the enforceable side, not yet adding up to relief physicians can feel." That nuance matters, because it points to the right posture: cautiously track the actual changes, without betting your operations on promises that have not yet materialized.

What to do about it

The practical conclusion writes itself. Do not build your operations around a voluntary promise with no enforcement and a poor track record. Watch whether your specific payers actually reduce requirements or speed decisions, and welcome it if they do, but do not staff, plan, or budget on the assumption that the pledge will deliver. Instead, put your effort where it reliably pays: reducing the prior authorization burden inside your own walls, which improves regardless of what any insurer pledges. Build the workflow that keeps auths moving in the Zero-Slip system and cut the denials that follow in this guide.

If you do want to track the pledge, keep it simple and specific to your payers rather than the national headlines. Note, per payer, whether the services you commonly request still require prior authorization, whether decision turnaround has actually improved, and whether denials now arrive with usable reasons. A short quarterly note on those three is enough to tell you whether a given insurer is delivering for your practice, which is the only version of the pledge that matters to your bottom line. Lean into any payer that genuinely improves, and keep your guard up with the rest. The national scorecard is discouraging, but your own payer-by-payer scorecard is the one that should actually drive your decisions, and it may look better or worse than the average depending on your specific mix.

The scorecard's real lesson is not that insurers are villains or saints; it is that a practice's leverage lies in what it controls, not in what it is promised. Track the promises, but bank on your own systems.

Where to go next

• Prior Auth Peer-to-Peer Requests: Scripts That Work (Free) live

  Free peer-to-peer prior authorization scripts: how to prepare and what to say to overturn a.

• 40 Prior Auths Per Physician, Every Week: 8 Numbers From the AMA's 2025 Survey live

  8 verified prior authorization statistics for 2026, sourced to the AMA's 2025 survey, Experian,.

• Independent Practice Operations in 2026: The Midyear Picture live

  The 2026 year in review for independent practices in numbers: ownership, prior auth, denials,.

• Gold Carding by State: AR, CO, LA, TX, WV, WY, and How to Qualify live

  Gold carding by state: what a prior auth gold card is, which states have it, how to qualify,.

Frequently asked questions

Sources

1. AMA pledge survey, 2026. ama-assn.org