TALLAHASSEE, Fla. — Every month, Mike Goldstein waits for more than medicine.
Before he can receive the infusion that treats his rare genetic disorder at Tallahassee Memorial HealthCare, he says he often has to wait for his insurance company to authorize it.
For Goldstein, the delays aren’t just frustrating.
“If there’s a delay for like more than a month or two at a time, I might not be able to stand up and talk to you right now for an interview, for example, walk around or do my day-to-day operations,” Goldstein told FOX49. “We need healthcare, but we need something that makes more sense for everyone involved.”
His experience reflects a broader debate playing out across Florida over prior authorization, the process insurance companies use to review and approve certain medical treatments before they’ll pay for them.
A new survey released by the Florida Hospital Association found prior authorization was the leading contributor to hospital discharge delays across the state between July 2024 and June 2025. Hospitals reported nearly 243,000 medically cleared patients remained hospitalized because of delays beyond their control, accounting for more than 781,000 unnecessary hospital days and an estimated $2.5 billion in preventable healthcare spending.
The association says those delays don’t just affect the patients waiting to leave.
When hospital beds remain occupied by patients who are medically ready for discharge, emergency department patients can end up waiting longer for an available room.
“It’s about the patient who’s had a stroke who needs to be discharged and benefit from a rehabilitation hospital or a skilled nursing facility, and they’re not getting the appropriate authorization from their insurance company to benefit from that rehabilitation,” Florida Hospital Association President and CEO Mary Mayhew said.
According to the association’s survey, nearly half of delayed patients were enrolled in Medicare Advantage plans, with prior authorization accounting for more than half of those delays. The report also found 41% of delayed patients were waiting for placement in a skilled nursing facility, illustrating that insurance approvals and post-acute care capacity often intersect.
Mayhew argues the problem isn’t simply paperwork.
“The vast majority of care that’s been denied, when we appeal it, we prevail,” she said. “So why is it being delayed or denied in the first place?”
Goldstein’s situation differs from the patients highlighted in the hospital association’s survey. Rather than waiting to be discharged, he says prior authorization has delayed treatment for his lifelong genetic condition.
He credits physicians and staff at Tallahassee Memorial for advocating on his behalf, but says communication between providers and insurers can leave patients caught in the middle.
“So the doctor, TMH has been great,” Goldstein said. “But then it’s they’re just waiting on Florida Blue to okay it every time.”
FOX49 reached out to AHIP, the national trade association representing health insurance providers, along with Florida Blue, Aetna, UnitedHealthcare and Humana.
In a statement, the organization said Medicare Advantage provides “better care at lower costs” than traditional Medicare and said health plans are working to streamline prior authorization while maintaining patient safeguards for safety, quality and affordability.
For Goldstein, the debate ultimately comes back to the patient.
“Every patient goes through those doors is a person, not just a notch on the board to check off,” he said. “If they could look more at the individualized cases of each patient that comes through those hospital doors, that seems like a good starting point.”