Canadians increasingly consider US care as delays, denials, and doctor shortages persist at home
Facing pressure from physicians, regulators, and growing public frustration, major US health insurers—including UnitedHealthcare and CVS Health’s Aetna—announced plans to scale back the use of prior authorizations that many say delay care and complicate treatment decisions.
These proposed reforms include reducing the number of medical claims that require pre-approval, expanding real-time decision responses, and standardizing the prior authorization process electronically by the end of 2025.
The changes will apply to employer-sponsored, individual, Medicare Advantage, and Medicaid plans.
For Canadian plan sponsors managing access and satisfaction under a public health system with persistent wait times, such developments may be relevant.
According to a March 2024 Ipsos poll cited by the Canadian Medical Association, 42 percent of Canadians said they would pay out-of-pocket for routine care in the US—up 10 percent from January 2023.
Emergency care interest also increased to 38 percent, rising 9 percent year over year.
The Canadian Medical Association noted several reasons Canadians consider cross-border care: faster access, unavailable procedures domestically, dissatisfaction with the system, and peer recommendations.
The data highlights growing pressure on Canadian health access as 6.5 million residents remain without a family doctor and many procedures—such as knee or hip replacements—fall outside the recommended wait time thresholds.
Dr. Ashley Sumrall, an oncologist from North Carolina, said she’s seen a growing number of prior authorization demands for MRIs—scans critical in monitoring tumour progression.
“There’s a term that we use called ‘scanxiety,’ and it’s very real,” she said in an interview with The Canadian Press. Sumrall also noted the inconsistency across insurers, stating that each “has their own way of doing business.”
Physicians have long warned that delayed approvals—even when they’re ultimately granted—can let diseases progress unchecked and heighten patient anxiety.
According to KFF’s 2023 review of Medicare Advantage claims, nearly all patients under those plans required prior authorization for some services, and insurers denied about 6 percent of those requests.
The December 2024 fatal shooting of UnitedHealthcare CEO Brian Thompson intensified scrutiny of prior authorization practices, prompting many to publicly voice long-standing concerns.
Mehmet Oz, now overseeing the Centres for Medicare and Medicaid Services, met with insurers ahead of the announcement.
At a press conference, Oz said, “There’s violence in the streets over this… Americans are upset about it.” He stated the Trump administration may pursue regulation if insurers fail to act: “You fix it or we’re going to fix it.”
Under the new plans, insurers say they will also honour prior approvals from previous providers during plan switches and commit to continuing claim reviews by “medical professionals.”
However, they have not guaranteed that the reviewers will come from the same specialty as the treating physician—a frequent concern among doctors.
While insurers have previously pledged to reform the system, critics note that little has changed.
Michael Anne Kyle, a University of Pennsylvania professor who studies health care access, told The Canadian Press that as health care costs rise, insurers increasingly use prior authorizations for prescriptions, lab tests, physical therapy, and imaging.
“We’re sort of trapped between care being unaffordable and then these nonfinancial barriers and administrative burdens growing worse,” she said.
The Canadian Medical Association emphasized that more robust data is needed to determine how many Canadians actually seek care abroad.
However, they stated that improving domestic access by reducing wait times, expanding hospital capacity, and streamlining referrals could reduce the need for cross-border treatment.
