By Aidan Sowa, CEO and Founder, Frontier Industries | October 2026
Insurers once communicated in two seasons: open enrollment and the annual report. That calendar is gone. Your company now gets judged in public every time a claim is denied, a prior authorization stalls, or a physician posts about a peer to peer call that went nowhere. This guide sets one test for the agency you hire: can this team defend your decisions in the language of the people those decisions land on, members, doctors and regulators, without a single sentence your own medical policy contradicts. Reverence for that test is rare, and it is the whole job.
| Measure | Figure | Source |
|---|---|---|
| Physicians saying prior authorization delays care | 93 percent | AMA survey, 2024 |
| Physicians linking prior auth to a serious adverse event | 29 percent | AMA survey, 2024 |
| Marketplace plan selections for 2025 coverage | 24.2 million | CMS, January 2025 |
I. Discrimen
Paying claims quietly is the product, and every denial is a publication
A health plan's brand is not built by advertising. It is built at the moment of refusal, thousands of times a day, in letters and portal messages most executives never read. Each denial creates an author: a member, a spouse, a physician, occasionally a journalist, each with a platform and a story where you are the antagonist by default.
The distinction your agency must grasp is between reputation and explanation. Reputation work assumes the audience starts neutral. Explanation work assumes the audience starts injured, and in this industry it usually does. An agency pitching you sentiment tracking and brand campaigns before it has read your denial letters and your appeal overturn rates is offering to decorate a house whose wiring is on fire.
Nobody frames your approval letter. They screenshot your denial.
This is why the classic agency offering, a brand tracker and a campaign calendar, misses the centre of your risk. Your most widely distributed documents are not advertisements. They are explanation of benefits statements, denial notices, appeal instructions and pharmacy rejection messages, read by millions of people at moments of maximum stress. Any agency unwilling to audit that document set, reading levels, tone, accuracy of next steps, is declining to work on your actual reputation while proposing to manage it. The first deliverable you should buy is that audit, priced honestly, because it will tell you more about your public standing than a year of sentiment dashboards.
II. Machina
Prior authorization is the machine that manufactures your headlines
Follow the arithmetic of grievance. The American Medical Association's 2024 survey of 1,000 practicing physicians found 93 percent reporting that prior authorization delays access to necessary care, 82 percent saying it can lead patients to abandon treatment, and 94 percent linking it to negative clinical outcomes (AMA, 2025). Most damaging of all, 29 percent of physicians said prior authorization had led to a serious adverse event for a patient in their care (AMA, 2025).
Physicians are the most trusted voice in American healthcare, and they complete an average of roughly 41 to 43 prior authorizations per physician per week, consuming about 12 hours (AMA survey reporting, 2024). That means your most credible critics interact with your least loved process dozens of times weekly, and then describe it on the record. An agency that cannot discuss prior authorization mechanics, gold carding, and the CMS interoperability and prior authorization rules in detail cannot manage your reputation, because your reputation is being manufactured there.
Your critics are not activists. They are your network, filling in your forms.
III. Exemplum
Medicare Advantage shows the two ways a plan can answer the data
When the HHS Office of Inspector General reviewed Medicare Advantage denials, it found that 13 percent of sampled prior authorization denials met Medicare coverage rules and likely would have been approved under traditional Medicare (HHS OIG, 2022, as reported in 2025 coverage of reform efforts). Two communication postures followed across the industry. Some plans treated the findings as an attack to be rebutted with aggregate statistics about overall approval rates. Others treated them as an audit to be answered: publishing appeal pathways, committing to faster turnaround, and explaining where criteria had been miscalibrated.
Watch which posture aged better. Regulators tightened transparency requirements anyway, and a 2026 industry analysis of the CMS mandates describes utilization management moving from manual, retrospective review toward documented, accountable processes (HealthHelp, 2026). The plans that had already been explaining themselves owned the narrative of reform. The rebutters became its targets.
Answer an audit like an audit. Anything else reads as a confession with better lighting.
IV. Damnum
The trust deficit is measurable, and it prices your growth
Distrust in this category is not a mood. It is surveyed, published and used by your competitors. Analysis of the 2025 Edelman Trust Barometer for health plans found that only 56 percent of consumers trust their health insurer to act in their best interests, and that the national average satisfaction score for commercial health plans sat at 563 on a 1,000 point scale (Heinrich, 2025). Meanwhile the top of your market keeps expanding: CMS reported a record 24.2 million consumers selecting Marketplace coverage for 2025, including 3.9 million new consumers (CMS, 2025).
Put those numbers together and you see the commercial stakes. Millions of shoppers choose plans during a short window, armed with low trust and high price sensitivity. Communications that assume loyalty will underspend on clarity. Communications that assume hostility will waste money on warmth nobody believes. The winning register is competence: accurate cost explanations, honest network descriptions, and denial processes a member can navigate without a lawyer.
Distrust is your acquisition cost now. Budget for it like one.
Provider relations belong in the same ledger. When a hospital system drops your network or a physician group campaigns against your authorization practices, the story is rarely really about rates. It is about accumulated friction meeting a news cycle. Plans whose agencies maintain genuine working relationships with provider communicators, sharing data early and arguing privately before arguing publicly, de escalate a striking share of these fights before they become network adequacy headlines. Ask candidate agencies which provider organisations they can call today, by name, and how those relationships survived the last public dispute they handled. Warmth is not the metric. Survival is.
V. Genus
The variable tightening around you is automated denial
One factor now decides how harshly your story gets told: whether a human visibly made the decision. AMA survey reporting in 2025 found 61 percent of physicians concerned that insurer use of AI in prior authorization is increasing denials, and 75 percent reporting that denials had risen over five years (Medical Economics, 2025). Regulators and legislators are converging on the same suspicion from different directions.
Your agency's craft here is precise language about human oversight: who reviews, what the algorithm may and may not do, how a member reaches a clinician. Vague reassurance about innovation will be read as confirmation. The companies that fare best publish their review architecture before they are subpoenaed for it. If your communications team cannot get that architecture documented with your medical and legal leads, it is not ready for the questions already being asked.
If a machine made the decision, say who supervised the machine. Silence will be filled in for you.
The same transparency logic applies to your pharmacy operation, where members meet your company most often and forgive it least. Formulary changes, step therapy requirements and specialty drug tiers generate the steadiest stream of member anger in the industry, and they are usually communicated in letters written to satisfy a filing requirement rather than a human being. An agency willing to rebuild those communications, what changed, why, what the alternatives are, what the member should do this week, buys more trust per dollar than any brand campaign you will ever approve. It is unglamorous work with an unfashionable name, member communications, and it is where your reputation is actually printed.
VI. Regio
Your audiences want contradictory things, in writing, simultaneously
| Audience | What they demand from you | Where the verdict forms |
|---|---|---|
| Members and families | Fast answers, human language, fair appeals | Denial letters, call recordings, local news |
| Physicians and hospitals | Fewer, faster, clinically literate authorizations | AMA surveys, specialty society campaigns |
| State regulators and legislators | Data on denials, turnarounds and overturns | Hearings, market conduct exams, statutes |
| Employers and brokers | Cost control they can defend to their own staff | Renewal meetings, benefits press |
| Investors | Medical cost discipline and membership growth | Earnings calls, trade coverage |
An agency serving a health plan must be able to write five honest documents that do not contradict each other, knowing each audience reads the others' copies. The member letter and the legislative testimony will be placed side by side eventually, usually by someone who dislikes you. Consistency under that condition is a discipline, and it is testable: hand candidates a denial scenario and ask for the member letter, the provider bulletin and the press statement. Compare them line by line.
Write every document as if your angriest reader owns the full set. One day, one will.
VII. Occasio
Open enrollment is a trust season, and almost everyone wastes it
The Marketplace calendar gives you an annual, predictable moment when tens of millions of people actively study health plans. CMS counted 24.2 million plan selections for 2025 coverage, more than double the 2021 figure (CMS, 2025). Most plans spend that window on price advertising indistinguishable from their rivals, then go quiet for eleven months while their denial stories circulate unanswered.
The opening is to treat enrollment as the start of an explanation year: plain language cost calculators, honest guidance on networks, published prior authorization commitments with turnaround data, and member education that reduces the misunderstandings which later become complaints. An agency thinking in this arc will show you a twelve month calendar, not a six week campaign. Ask to see it in the pitch.
The cheapest trust you will ever buy is a clear answer given before anyone is angry.
Enrollment season also exposes your broker and employer channels, whose staff repeat your explanations to hundreds of employees and remember which plan armed them honestly. Equip them like the audience they are: cost scenario sheets, network change briefings written before the rumours, and named contacts for the hard cases. An agency that includes the channel in the communications plan, rather than treating enrollment as a consumer media buy, understands where plan choices are actually made in the group market.
VIII. Structura
A regional plan can out explain a national carrier, and members prefer it that way
Scale buys a health plan many things, but not believability. Regional and provider sponsored plans hold a structural advantage in this market: their executives live in the coverage area, their medical directors trained with the physicians criticising them, and their denial data can be published at a granularity national carriers avoid. Edelman's health research describes influence localising across healthcare, with community voices gaining ground on national institutions (Edelman, 2025). That trend is a gift to the smaller plan willing to be specific.
Your agency should be able to exploit local structure rather than imitate national scale: named medical directors speaking on the record, community level turnaround statistics, partnerships with the very provider groups your members use. A big budget spent sounding big is, in this industry, a suspicious expense.
Near is a strategy. A plan that can be found can be believed.
Medicare Advantage plans live under an additional published verdict that commercial plans escape: CMS Star Ratings, released each autumn, scored in public and wired directly into quality bonus payments and enrollment behaviour. Seniors shop with the stars open in another tab, brokers steer by them, and a one star slide is a trade press story with your name in the headline. Your agency should treat the ratings calendar as a communications season of its own: preparing honest explanations of measure level movement, equipping brokers before members call, and resisting the temptation to market a rating your operations have not yet earned twice. A plan that explains a three and a half star year candidly will be believed in its five star year. One that spins both will be believed in neither.
IX. Consilium
Buy regulatory fluency and member empathy in the same team, or do not buy
| Agency option | Fit for a health plan | Principal risk |
|---|---|---|
| Healthcare policy and communications firm | Fluent in CMS rules, state oversight and reform politics | Member facing writing can turn bureaucratic |
| Consumer brand agency with health clients | Warm, clear member campaigns and strong creative | Likely to underestimate denial and appeals scrutiny |
| Crisis led consultancy | Excellent under legislative and media fire | May neglect the steady explanation work that prevents fires |
| Public affairs agency | Strong with regulators, legislators and employer coalitions | Provider and member credibility can lag |
| In house team with specialist agency support | Control over sensitive language, continuity | Hard to staff policy, consumer and crisis depth simultaneously |
| Criterion | Weight | Evidence to demand |
|---|---|---|
| Prior authorization literacy | High | A critique of your own PA communications, researched unaided |
| Regulatory calendar command | High | Their map of your CMS and state reporting obligations |
| Member language testing | High | Examples of denial or appeal copy rewritten to plain reading levels |
| Physician audience credibility | Medium | Provider facing work that specialists did not mock |
| Crisis and hearing preparation | Medium | A named lead with testimony or hearing experience |
The companion healthcare guides are collected in the resources index, and engagement models are described on the services page. Plan leaders thinking about technology vendors should also read the guide for digital health startups, whose buyers and regulators increasingly overlap with yours.
Frequently asked questions
Can PR actually fix a reputation built on claim denials?
No, and distrust any agency that says yes. Communications can explain decisions fairly, surface appeal routes, publicise reforms with data, and stop unforced errors in letters and scripts. If denial patterns themselves are indefensible, the fix is operational, and the honest agency tells you that in the first meeting.
How should we respond when a denial story goes viral?
Acknowledge the member's experience without litigating their case in public, state the review and appeal pathway, commit to direct contact, and then actually resolve it through the proper channel. The audience is every other member watching how you behave under pressure, not the comment thread.
What prior authorization data should we publish voluntarily?
Turnaround times, approval rates by category, appeal volumes and overturn rates, presented in plain language with methodology notes. The direction of regulation is toward mandatory transparency anyway (CMS rules summarised in industry analyses, 2026). Publishing first converts an obligation into evidence of confidence.
Should our medical directors be public spokespeople?
Yes, selectively. Physicians trust physicians, and members respond to a named clinician explaining a policy more readily than to a corporate statement. Prepare them properly: media training, clear boundaries on individual cases, and scientific backup for every claim.
How do we communicate an AI driven review process?
Describe the division of labour: what the system assembles, what a clinician decides, how a member reaches a human, and what your audit process checks. Publish it before a regulator or a newsroom describes it for you, in their vocabulary rather than yours.
What should our agency report each quarter?
Movement in trust and friction: member comprehension testing, complaint themes, appeal outcomes, provider sentiment, accuracy of coverage on denial and reform stories, and enrollment season performance. Sentiment scores alone hide the machinery that creates them.
Is a national agency necessary for a multi state plan?
Not necessarily. You need state level regulatory awareness in each market you serve, which a strong healthcare firm can staff or partner for. Test with a scenario set in your most difficult state, not in your headquarters market.
How this guide was built
This guide draws on the American Medical Association's physician survey programme on prior authorization, CMS Marketplace enrollment reporting, HHS Office of Inspector General findings as covered in reform reporting, Edelman Trust Barometer health analysis and industry summaries of the CMS utilization management mandates. Two limits apply. Survey findings about prior authorization reflect physician experience, which is informed and also interested; member surveys would shade some numbers differently. Enrollment and policy facts reflect the 2025 coverage year and rules documented into 2026, and this policy area changes quickly enough that your agency should be re-verifying the calendar quarterly, not annually.
X. Incipe
Where Frontier Industries fits in this decision
Frontier Industries works with healthcare organisations whose explanations get audited by regulators, physicians and members at the same time. For health plans, the practice concentrates on the machinery this guide describes: denial and appeals language, prior authorization transparency, enrollment season clarity, and leaders who can defend policy on the record. You can meet the team on the about page and compare approaches in the sibling guide for assisted living facilities, another industry where family trust decides everything.
If you are selecting now, bring your toughest denial scenario and ask every finalist to draft against it. Start the conversation through the industry campaign page or call 401-219-4207.
Sources
1. American Medical Association, The AMA is ready to help CMS fix prior authorization, reporting the 2024 AMA prior authorization physician survey. https://Www.Ama-Assn.org/practice-management/prior-authorization/ama-ready-help-cms-fix-prior-authorization 2. American Journal of Managed Care, AMA Survey Highlights Growing Burden of Prior Authorization on Physicians, Patients. https://www.ajmc.com/view/ama-survey-highlights-growing-burden-of-prior-authorization-on-physicians-patients 3. Becker's Hospital Review, Prior authorization is 'wreaking havoc': AMA survey, 2024. https://www.beckershospitalreview.com/finance/prior-authorization-is-wreaking-havoc-ama-survey/?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter 4. Centers for Medicare and Medicaid Services, Nearly 24 Million Consumers Have Selected Affordable Health Coverage in ACA Marketplace, 2025. https://www.cms.gov/newsroom/press-releases/nearly-24-million-consumers-have-selected-affordable-health-coverage-aca-marketplace-time-left 5. Centers for Medicare and Medicaid Services, Marketplace 2025 Open Enrollment Period Report: National Snapshot. https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-period-report-national-snapshot-2 6. Heinrich Marketing, The Best Way Health Insurers Can Earn Back Consumer Trust, analysing the 2025 Edelman Trust Barometer, 2025. https://heinrich.com/thoughts/the-best-way-health-insurers-can-earn-back-consumer-trust/ 7. Medical Economics, Physicians warn that AI will undermine judgment, increase prior authorization denials, 2025. https://www.medicaleconomics.com/view/physicians-warn-that-ai-will-undermine-judgement-increase-prior-authorization-denials 8. TechTarget, Prior authorizations often denied, adding to provider burden, 2024. https://www.techtarget.com/revcyclemanagement/news/366600103/Prior-authorizations-often-denied-adding-to-provider-burden 9. InsuranceNewsNet, Rep. Bresnahan pushes for prior authorization reform in Congress, citing the AMA survey and the HHS OIG Medicare Advantage review, 2025. https://insurancenewsnet.com/oarticle/rep-bresnahan-pushes-for-prior-authorization-reform-in-congress 10. HealthHelp, Navigating 2026 CMS Mandates, on utilization management transparency requirements. https://www.healthhelp.com/wp-content/uploads/Navigating-2026-CMS-Mandates_Final.pdf