Administrative burdens from coverage delays and denials are hardly isolated to patients. In fact, physicians bear many of the costs of not only learning what is likely to be covered under their patients’ health plans, but also helping patients to appeal denials. This can elicit substantial frustrations because “peer to peer” processes are not closely regulated by states, such that cases are reviewed by physicians in inappropriate specialties. What’s more, prior authorization burdens can require substantial staffing to administer – staffing that less well-resourced practices may not be able to support. Thus, there are inequities not only in patient experiences of denials and their subsequent health care access, but also across medical practices, the effects of which can trickle down to their patients. Drawing on interviews with physicians across the country, this chapter highlights the ways that the tools of managed health care – while aiming at cost containment and guarding against overutilization – can lead to physician administrative burden, underprescribing to avoid further burden, and even contribute to the public health crisis of physician burnout.