Six in 10 Patients and Caregivers Facing Prior Authorization Delays or Denials Have Given Up on Care, Penguin Ai Survey Finds

87% would support AI that speeds approvals, most of them on the condition of human oversight

• 62% of respondents who faced a prior authorization delay, denial, or medication restriction say they have given up on care because fighting their insurer wasn't worth it.
• Only 44% of respondents appealed an insurer's decision, and 47% of those who appealed won.
• Denials and delays led 36% of respondents to pay out of pocket and 21% to skip care entirely.
• 87% would support AI that gets approvals decided faster and more accurately, including 49% whose support depends on human oversight.

PALO ALTO, Calif., Nov. 12, 2026 /PRNewswire/ -- Patients and caregivers are giving up on care rather than fight their insurer over prior authorization. In a national survey of 500 U.S. adults commissioned by Penguin Ai, 62% of those who faced a delay, denial, or medication restriction say they have given up on care because fighting their insurer wasn't worth it. Across the full sample, 48% say the same.

Every respondent needed at least one prior authorization for themselves or a family member in the past two years. More details on the findings can be found here.

"Six in 10 people who faced a delay or denial gave up on care. Among the people who appealed, nearly half got the decision reversed," said Fawad Butt, co-founder and CEO of Penguin Ai. "Patients are leaving a process that often rules in their favor. Health plans and providers can keep more patients from giving up by putting complete clinical information in front of reviewers on the first submission."

How Long Do Patients Wait for a Prior Authorization Decision?

Most wait four days or longer (62%). Only 14% of respondents received a same-day decision. The most common wait was four to seven days (29%), and about one in three respondents waited a week or longer or were still waiting when they took the survey.

What Happens to Patients After a Prior Authorization Delay or Denial?

Respondents reported the following outcomes after a denial or delay:

• 36% paid out of pocket
• 32% delayed care
• 21% skipped care entirely
• 17% went to an emergency room or urgent care instead
• 13% said their symptoms or health got worse

Only 20% reported none of these outcomes.

Respondents also lost time to phone calls and paperwork with their insurer, including appeals. Seventy percent spent at least an hour, and 16% spent more than five hours. Nearly half (49%) rated their stress a 4 or 5 out of 5.

How Often Do Patients Appeal, and How Often Do They Win?

Patients who appeal win nearly half the time. Of the 44% of respondents who appealed, 47% had the decision overturned and 24% saw it upheld. Another 20% were still waiting for an outcome, and 8% gave up partway through.

How Do Patients Feel About AI in Coverage Decisions?

Most don't know whether AI played a role. Only 8% of respondents were told AI or automated software was involved in their decision. Another 32% suspect it was, and 32% have no idea.

Most say AI involvement would make a denial worse. Sixty-nine percent would be more upset if they learned AI made or recommended a denial, and 54% say they would switch insurers if they knew AI was used to review claims.

What Would Make Patients Comfortable With AI in Prior Authorization?

Respondents were asked whether they would support AI that gets approvals decided faster and more accurately, with insurers and doctors working from the same information. Thirty-eight percent said yes, and 49% said their support depends on human oversight. Thirteen percent said no.

"Most patients will accept AI in prior authorization when a person oversees the decision," Butt said. "They want someone accountable for every denial. AI should assemble the clinical evidence before a reviewer opens the case. Then the reviewer can focus on the clinical judgment, and the patient gets an answer sooner."

Penguin Ai's Intelligent UM prepares each prior authorization case with the clinical documentation mapped to medical necessity criteria, and a clinician signs off on every recommendation before it issues. Appeal outcomes feed back into the review process so health plans can correct the criteria and documentation problems behind overturned decisions.

About the Survey

Penguin Ai commissioned the consumer survey, which was fielded in November 2026 among 500 U.S. adults. Percentages reflect all 500 respondents unless noted. The 62% figure reflects the 273 respondents who reported a delay, denial, or medication restriction.

Fawad Butt is available for interviews on the findings.

About Penguin Ai

Penguin Ai builds agentic infrastructure for healthcare administration. Payers, providers, and risk-bearing organizations use its platform, GwenOS, for prior authorization, HCC coding and risk adjustment, claims adjudication, payment integrity, appeals, and other administrative work. GwenOS connects to the systems they already run, including Snowflake, AWS, and Databricks, to reduce administrative burden and improve financial performance. Founded by the former Chief Data Officer of Kaiser Permanente, UnitedHealthcare, and Optum, Penguin Ai is on a mission to reduce the $1 trillion annual cost of healthcare administration inefficiencies. To learn more, visit www.penguinai.co.

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SOURCE Penguin Ai