Your prior authorization stories matter

See how patients and physicians around the country are affected by this burdensome and ineffective process.

If we try to do the work ourselves, our limited staff is taken away from patient care for 30-45 minutes with each incident. PA directly devalues the doctor-patient relationship.
– Dr. Windslow M.
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If we try to do the work ourselves, our limited staff is taken away from patient care for 30-45 minutes with each incident. PA directly devalues the doctor-patient relationship. It creates a hostile work environment within my office staff as the process is demeaning and abusive. I want to retire ASAP.

– Dr. Windslow M.
One of the biggest reasons why I just couldn't practice any longer was prescription prior authorizations.
– Dr. Louann W.
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I retired a year ago after 38 years in the same office. One of the biggest reasons why I just couldn't do it any longer was prescription prior authorizations. I would sometimes work for 3 months to get an approval only to find out that the patient could not afford the $900 co-pay. (Yes, one patient's copay for a specialty injectable was $900!) … It made me so angry!”

– Dr. Louann W.
I tried to obtain authorization for Lupron-Depot therapy, but was denied with the excuse that I had not exhausted other treatment modalities.
– Dr. David K.
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I tried to obtain authorization for Lupron-Depot therapy, but was denied with the excuse that I had not exhausted other treatment modalities such as Danazol. Do they really expect me to put this vulnerable patient, who is already both physically and mentally devastated by her endometriosis, on this horrendous medication? Both the patient and her mother are now literally begging me to do a hysterectomy and bilateral salpingoophorectomy on this 18-year old to relieve her of the torture she goes through on a monthly basis.

– Dr. David K.
We actually have prior authorizations pending with a total of 119 pages.
– Dr. Rajat D.
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I have one dedicated staff member who has primary responsibility for all prior authorizations. From an 8-hour work day she dedicates 6 of them to prior authorizations. This is uncompensated care. Written prior authorizations most recently have increased in the number of pages that have to be filled out. We actually have prior authorizations pending with a total of 119 pages. Valuable time is spent away from patient care. What is most obnoxious is that there is no medical rationale in demanding the prior authorization…Frequently, there is no point of contact that can make a medical decision on the other end of the phone…Standard of care is affected by this entire egregious process…I could go on, but at this point it feels like a no-win situation where you are forced to submit to the demands of the pharmacy benefit manager.

– Dr. Rajat D.
Why do insurance companies have more power over our health than us and our doctors?
– Ellyn W.
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Why do insurance companies have more power over our health than us and our doctors?

– Ellyn W.
I think prior authorization is a ridiculous thing. If your doctor, in whose hands your life stands, thinks you need it, that should be it.
– Diane H.
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Prior authorization is a dirty word in my book. This last time, I needed a medication I had previously been on for about 14 years. I had to stop it previously, as it became unavailable. I used another medication in its place and did not do well. The first medication became available again and I asked that it be prescribed once again. Done! That was on February 12. Through a mess of wrong phone numbers, wrong fax numbers, being away from home, etc. etc. etc. I just got the prior authorization yesterday on March 29. Took 6 weeks. Thank goodness it was not heart medicine. I think prior authorization is a ridiculous thing. If your doctor, in whose hands your life stands, thinks you need it, that should be it.

– Diane H.
Do I hold my breath while waiting 3 days to breathe with inhalers? It's like a game of chess.
– Joyce W.
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Do I hold my breath while waiting 3 days to breathe with inhalers? It's like a game of chess.

– Joyce W.
I waited 6 days to get approved for Fentanyl patches for my cancer.
– Cozetta C.
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I waited 6 days to get approved for Fentanyl patches for my cancer. My oncologist sent the prior authorization too. But these decisions are made on business days. So I had to suffer.

– Cozetta C.
Everything my pain management doctor had tried to get for me through a prior authorization has been denied. Now I’m just in constant pain.
– Sherri H.
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Everything my pain management doctor had tried to get for me through a prior authorization has been denied. Now I’m just in constant pain and not able to do anything—much less enjoy the day. It’s ridiculous that all the sudden I have to have a prior authorization when they have covered it since 2006. It’s just outrageous what they are doing to us…I can’t afford to eat and purchase all the meds, so I have to make hard decisions.

– Sherri H.
The whole prior authorization program is a farce anyway. All they do is ask me if I really need the medicine and did I try another.
– Dr. Richard L.
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Patients come to me for help, but I am shut down by the prior authorization system routinely. I cannot recall a single antibiotic that has been approved without PA except for Bactrim in the past 3 months. Imagine, a urologist is not allowed to prescribe for immediate treatment of UTIs. I get less hassle for CT scans actually. The whole PA program is a farce anyway. All they do is ask me if I really need the medicine and did I try another. If they have another suggestion it should be made automatically and I should have the ability to bypass it. They even reject antibiotics that are free at local pharmacies. It is absurd and wasteful and harmful.

– Dr. Richard L.
Prior authorization was very detrimental to a very close friend of mine.
– Becca N.H.
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Prior authorization was very detrimental to a very close friend of mine. My friend has diabetes, severe hypertension, CKD-Stage 2, anemia and is legally blind secondary to diabetic retinopathy. In the spring of 2016 her primary care physician wrote a letter of prior authorization. He wanted to get her insurance company to approve a Catapress patch for treatment of her hypertension, because she could not tolerate the oral form of the medication without significant blood pressure fluctuations causing significant hypotension and hypertension. My friend was hospitalized that fall secondary to uncontrolled hypertension with edema and during that hospitalization they used the Catapress patch and her blood pressure finally stabilized. She has been using that medication ever since and now has well controlled blood pressure. It would seem the insurance company would have been wise to initially listen to the trained physician instead of paying for a hospitalization to come to the conclusion that my friend needed this medication.

– Becca N.H.
It absolutely INFURIATES ME when I have to call someone who doesn't know the difference between a jaw and sinuses yet has the power to deny a patient a study or treatment.
– Dr. Elizabeth S.
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PA affects me absolutely f***inglutely. I'm an internist in a rural north GA town. It absolutely INFURIATES ME when I have to call someone who doesn't know the difference between a jaw and sinuses yet has the power to deny a patient a study or treatment. They are so completely unaware of anything medical and I had to go through at least 10 years of training before I could touch a patient.

– Dr. Elizabeth S.
Did a nephrectomy on a patient and sent him a prescription for pain medication—same ones he was getting in the hospital—and the pharmacy would not fill without a prior authorization from me.
– Dr. Berry B.
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Did a nephrectomy on a patient and sent him a prescription for pain medication—same ones he was getting in the hospital—and the pharmacy would not fill without a prior authorization from me. Patient had to go to the ER to get some pills. How much do you think that saved the insurance company?

– Dr. Berry B.
[Prior authorization is] leaving patients with severe depression and hallucinations untreated with delays ranging from days to weeks.
– Dr. Heather V.
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I am a pediatrician, and I find prior authorizations to be a huge burden to my office's productivity. Additionally, I have experienced significant delays getting my patients the treatments that they need, including life-saving treatments such as epinephrine autoinjectors for anaphylaxis and inhalers for asthma. I also struggle getting medications approved for ADHD, acne, and even some critically important psychiatric medications, leaving patients with severe depression and hallucinations untreated with delays ranging from days to weeks.

– Dr. Heather V.
Prior authorization significantly interferes with patient care.
– Dr. Emilio G.
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Prior authorization significantly interferes with patient care Insurance companies are practicing medicine without a license and without holding any responsibility or liability… it is amoral to have CEOs and other officials make millions of dollars in compensation at the expense of people’s illnesses and misery. It is indefensible. Period.

– Dr. Emilio G.
I recently spent over 10 hours trying to get a patient's surgery authorized.
– Kathy D.
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I work with a surgeon, treating breast cancer patients as the majority of our patients. I recently spent over 10 hours trying to get a patient's surgery authorized.

– Kathy D.
The authorization was rejected, so I appealed. It was rejected again, even though I pointed out to the agent on the other end of the line that the patient met the criteria.
– Dr. Sussana L.
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My patient met the insurance company's prior authorization criteria, which was reasonable. Yet, the authorization was rejected, so I appealed. It was rejected again, even though I pointed out to the agent on the other end of the line that the patient met the criteria. I was about to give up, but decided to call the medical director of the insurance company instead, who granted authorization. I wonder how many people would have given up rather than continue the fight and how much money the insurance company thought it was saving by denying legitimate drug use.

– Dr. Sussana L.
We did a project to track what percentage of prior authorization requests from my private rheumatology practice were approved in 12/2017-1/2018. It was a 95% approval rate—some after 4 appeals, and countless hours of time and effort.
– Dr. Irene K.
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We did a project to track what percentage of prior authorization requests from my private rheumatology practice were approved in 12/2017-1/2018. It was a 95% approval rate—some after 4 appeals, and countless hours of time and effort. The delays it causes prolongs patient pain and suffering and leaves patients vulnerable to permanent joint damage and in some cases organ damage while waiting for this unnecessary administrative barrier to be surmounted. Enough is enough...

– Dr. Irene K.
My experience with prior authorizations, like that of so many Americans, has been horrendous to say the least.
– Lilly H.
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My experience with prior authorizations, like that of so many Americans, has been horrendous to say the least. I have literally waited an entire week for simple medications ... It has proven absolutely detrimental to getting proper medical treatment and has negatively impacted my own personal recovery many times over. It has gotten so far out of control that even a simple antibiotic such as 'Amoxicillin' now requires prior authorizations and it's even in its generic form!?!

– Lilly H.
If my doctor had not given me samples, (it took over two weeks for the authorization to go through) I would have possibly been dead.
– Kathy D.
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I have been taking a medication that truly keeps me alive for 5 years. The last time I went to get my script I was told I could not have it unless my doctor got prior authorization for that medication. I, of course, was low on that medication, picking my script up with a few pills left in my bottle. If my doctor had not given me samples, (it took over two weeks for the authorization to go through) I would have possibly been dead. After five years they decide I need prior authorization….

– Kathy D.
Prior authorizations are the hidden additional cost of delivering healthcare.
– Joseph T.
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Prior authorizations are the hidden additional cost of delivering healthcare. Each physician needs one full time staff member just to obtain prior authorizations. Items such as durable medical equipment, walking casts or splints costing less than $150 require at least 15-20 minutes of staff time for a prior authorization. This isn't the delivery of healthcare, this is rationing health services by making it too burdensome for patients to use the health insurance they are paying for.

– Joseph T.
Never have I encountered a reasonable situation where filling out a prior authorization was important either for the patient or myself.
– Dr. Kartik K.
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Never have I encountered a reasonable situation where filling out a prior authorization was important either for the patient or myself. It can delay important medications after a discharge if a PA need is not known prior to discharge and delays therapy. It is a process that could be applied after the fact if there was cost saving concerns rather than delay potential therapy. Absolutely ridiculous, inefficient, and benefits neither the patient or physician and has the potential to do more harm than intended benefit of potential cost-savings for the insurance industry!

– Dr. Kartik K.
I have been on this medication for years, so for the insurance company to basically ask the doctor to provide more paperwork saying I need it is BS!
– Megan L.
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I was getting ready to leave for a trip and had my doctor’s appointment the day before. Afterwards I took my scripts to be filled at the pharmacy and intended to pick them up the next day, giving them plenty of time. They called the next morning and said they needed prior authorization from my doctor and she was not open on Friday, so I had to postpone this important trip because it is a medication I cannot just stop taking. I have been on this medication for years, so for the insurance company to basically ask the doctor to provide more paperwork saying I need it is BS! Of course I need it or she would not have prescribed it. It was so frustrating!!!!!

– Megan L.
That works out to 48 weeks of trying medications we already knew would not work, before I could hope to get the medication we already knew did work.
– Lyle S.
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I saw my gastroenterologist about my gastroesophageal reflux disease (GERD). He gave me samples of Dexilant and wrote a prescription for it. Within three days of switching to Dexilant, the chronic cough was gone. The insurance company, different than the one I had before, required prior authorization for Dexilant. The insurance company would not cover the prescription until I tried three other medications. My doctor gave me prescriptions for the medications, one after the other and they did not work. Then the insurance company informed us that trying each medication means 8 weeks taking it once per day, then 8 weeks taking it twice per day. That works out to 48 weeks of trying medications we already knew would not work, before I could hope to get the medication we already knew did work. By the time the 48 weeks elapsed, the insurance policy ended, and I had to get a policy with a new company, who wants me to jump through the same hoops. More than a year after trying to get Dexilant, I still have my chronic cough and no hope in sight of actually getting the medication I need. Without an effective treatment for GERD, I am at increased risk of several problems, including esophageal cancer.

– Lyle S.
Prior authorizations take up significant staff resources. In the majority of cases, prior authorizations delay treatment, which in psychiatry can have dangerous consequences.
– Dr. Howard L.
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Prior authorizations take up significant staff resources. We have a full-time nurse and per diem nurse coming in every day spend all day doing prior authorizations instead of helping care for patients or addressing patient concerns. Limiting physician choices in management prevents doctors from providing individualized care to patients. In the majority of cases, prior authorizations delay treatment, which in psychiatry can have dangerous consequences.

– Dr. Howard L.
My insurer required me to try another drug at a huge co-pay to me before they would consider filling my prescription.
– Cathy M.
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Side effects of the most common diabetes treatment drug made it impossible for me to take. The doctor gave me samples of the drug he felt worked best. My insurer required me to try another drug at a huge co-pay to me before they would consider filling my prescription. They then required the doctor to justify not keeping me on the drug they wanted me to use and then filled it for only three months.

– Cathy M.
I had an elderly lady with terminal cancer present a prescription for pain medication on a Friday evening only to have the health plan require prior authorization. . . The lady went without her pain medication until Monday when the health plan got back to us.
– Dennis C.
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As a pharmacist working for Wal-Mart, I had an elderly lady with terminal cancer present a prescription for pain medication on a Friday evening only to have the health plan require prior authorization. When I called them, explaining her situation, they responded that there was nothing they could do until Monday. The lady went without her pain medication until Monday when the health plan got back to us.

– Dennis C.
I've been denied a treatment that worked for 11 years.
– Gina F.
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I've been denied a treatment that worked for 11 years. Eight years I've been fighting for it. Denied for the last time.

– Gina F.
I had a loose titanium knee and it took me almost two months to get surgery due to all the hoops & phone calls to get through.
– Kim R.M.
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I am an ex-nurse and a disabled veteran … I had a loose titanium knee and it took me almost two months to get surgery due to all the hoops & phone calls to get through. Because of the wait my loose knee had chewed up the top of my tibia which had to be replaced with some more metal after cleaning out the necrotic tissue & bone. There are real consequences to such a wait.

– Kim R.M.
I am one case out of hundreds that my surgeon has to spend hours upon hours needlessly playing phone tag.
– Eva T.
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I am one case out of hundreds that my surgeon has to spend hours upon hours needlessly playing phone tag and writing petitions for his patients so he can provide the care he wants. Outrageous. Exhausting the client and the doctor while keeping our premiums.

– Eva T.
I recently had a patient die due to needing a prior authorization for cefpodoxime axetil for a UTI.
– Dr. Phillipe K.
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I recently had a patient die due to needing a prior authorization for cefpodoxime axetil for a UTI.

– Dr. Phillipe K.
This arguing lasted about 3 days - 3 more days of delaying carefully timed treatment that is helping him to stay in a sort-of remission state.
– Nancy C.
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My son is 20 and has Crohn’s disease… The health plan insisted that he switch product brand, because of their insurance contract with said company. His immunologists from both coasts argued in writing and on the phone that since he has no antibodies to the antigens in that brand, it would surely cause an allergic reaction/hospital admission. This arguing lasted about 3 days - 3 more days of delaying carefully timed treatment that is helping him to stay in a sort-of remission state, by the skin of his teeth...It isn't wise and it isn't fair to add this burden to patients and their families, because living with and managing chronic illness is already fraught with many barriers. I am so exhausted.

– Nancy C.
I have to do a prior authorization every time to get liquid antibiotics.
– Kimberly H.
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I am a nurse practitioner. I see this every day, in many different ways. One of the biggest problems I face is that one insurance company has made it a policy that they will not approve liquid antibiotics for anyone over the age of 11. I have several patients with G-tubes that can NOT swallow. I have to do a prior authorization every time to get liquid antibiotics.

– Kimberly H.
When I started here the only procedures requiring prior authorizations were surgeries. Now medications, radiology, and in-office procedures require prior authorization or you do not get paid.
– Robin S.
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I work at a urology practice. When I started here the only procedures requiring prior authorizations were surgeries. Now medications, radiology, and in-office procedures require prior authorization or you do not get paid. Often new prior authorization requirements are buried deep within some emailed network bulletin. Insurers are famous for changing prior authorization requirements. They just started requiring us to request prior authorizations on all chemo medications injected or infused through a portal. The questions are often confusing and time consuming even to the physicians. We have had patients that have had to put off certain treatments because it takes so long to get a prior authorization back or the hoops we have to jump through are increasingly tedious.

– Robin S.
All prior authorizations are done by me. As a psychiatrist, I book my schedule as tightly as possible, so these extra phone calls, being on "perma-hold" for 10-25 minutes, takes a big bite out of my time.
– Dr. Dennis L.
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I have no admin back-up. All prior authorizations are done by me. As a psychiatrist, I book my schedule as tightly as possible, so these extra phone calls, being on "perma-hold" for 10-25 minutes, takes a big bite out of my time. Not to mention that they often are on the mainland, and there is a 2-3 hour difference in time zones between Hawaii and California. Not to mention the 5-6 hour difference to the East Coast, so it's hard to do this at the end of the day for me. A colossal waste of my time, a never-ending source of frustration, and frankly, another thing to push me towards retirement, and I know that there is still a shortage of private psychiatrists in my state.

– Dr. Dennis L.
These prior authorizations are putting people at high unnecessary health risks. Please help to put a stop to this method.
– Cindy H.
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I have the gene that makes my cholesterol go extremely high and diet or exercise won’t help. I cannot take statins. I have tried it all. The only medicine that I can take is Repatha. I have been trying since this last October to get my Repatha refill…I am still in the waiting process; my cholesterol is now high again from the waiting game because of this prior authorization. These prior authorizations are putting people at high unnecessary health risks. Please help to put a stop to this method.

– Cindy H.
They have some damn nerve acting against doctors' wishes for their patients!
– Kathleen G.
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They have some damn nerve acting against doctors' wishes for their patients! My doctors have gotten very angry when it happens and have fought successfully to override it but they shouldn't HAVE TO fight to treat their patients!

– Kathleen G.
I save applying for prior authroizations until the end of the day to keep me from swearing out loud when there are patients around.
– Dr. Donna C.
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I save applying for prior authorizations until the end of the day to keep me from swearing out loud when there are patients around. My blood pressure goes up. In the last week I have had rejections (for rheumatology drugs) by a "bought and paid for" ER doc and radiologist.... I have to then write an appeal letter and "remind" the reviewer that these persons have rendered a verdict outside of their areas of expertise. I almost always get a rejection overturned, but the waste of time and energy is overwhelming to me—let alone the patient when that person needs care ASAP. Every year the insurers get deals on different drugs and then the whole tier action gets redistributed and folks who have been on certain meds for YEARS and in good control without side effects are thrown to the wolves and FORCED to get on a drug that may cause significant side effects. (My blood pressure is rising as I write this... I'd better stop now!!)

– Dr. Donna C.
My doctor had to fight to get me a prescription that had been authorized, but then when the form was sent in, they decided they needed another authorization.
– Carolyn M.
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My doctor had to fight to get me a prescription that had been authorized, but then when the form was sent in, they decided they needed another authorization. It took 2 months.

– Carolyn M.
I have seen patients not able to get their Depo-Provera shots in time due to need for prior authorization.
– Dr. Gina C.
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I have seen patients not able to get their Depo-Provera shots in time due to need for prior authorization and patients that have to wait for PA in order to schedule their required imaging, causing at least a 1-2-week delay. This is UNNECESSARY and frustrating when you think that the patient shouldn’t need to wait that long (seeing how if they were in the ER, they wouldn't have to wait, but rather you are going to punish the patient for going to their PCP instead?? BACKWARDS!!!). These are just the 2 examples from my last week in practice...and do not get me started on the amount of time (easily hours!) my staff spends EVERY week filling out prior authorization forms for medications, some of which are merely continuations of therapy medications for patients.

– Dr. Gina C.
Every time I get a prior auth I want to scream! These take my staff away from actually helping me with practicing medicine.
– Dr. Deborah S.
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Every time I get a prior auth I want to scream! These take my staff away from actually helping me with practicing medicine. Then we spend countless hours on doing these and half the time we get them covered the patient's co-pay is too high for them to afford. I always start with the cheapest medications first and only go to new ones when these have failed. This is just a stalling tactic for insurance to keep from paying for a more expensive medication.

– Dr. Deborah S.
I have had to make multiple calls and wait as long as 2 weeks trying to obtain authorization for an MRI when there were abnormal mammogram or pelvic sonogram findings.
– Dr. Nina S.
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I have had to make multiple calls and wait as long as 2 weeks trying to obtain authorization for an MRI when there were abnormal mammogram or pelvic sonogram findings. The patients become increasingly anxious about their condition and sometimes angry at me because they think I’m either withholding care or not concerned about their needs.

– Dr. Nina S.
I have only seen this process get more and more difficult to navigate. I feel it does not serve the patients nor the doctors and staff.
– Deborah C.
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Prior authorization has become a nightmare. I cannot tell you how many times I receive incorrect information (i.e. call three different people and get three different answers. This doesn't make me feel confident). As well as the fact when you do call as the patient is waiting for treatment the doctor and his technicians are waiting to do their job, you are on hold. You jump through hoops to finally get through to a live human being, only to give the same info you have given three or four times already. It backs up our entire day and flow. Not to mention the back of the insurance cards do not always give the pharmacy benefit manager so you are re-routed to maybe one (if lucky) or two different departments. As a healthcare worker for more than thirty-five years, I have only seen this process get more and more difficult to navigate. I feel it does not serve the patients nor the doctors and staff. We try to treat and care for our patients with the best intent with our hands tied.

– Deborah C.
The day before the test the hospital called to say the prior authorization had not been received. My daughter passed away the day before we were supposed to go for the rescheduled test.
– Kathy M.
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My daughter had ALS. Her doctor ordered a PET scan of her brain. The appointment was set, medical transportation was set, co-pay paid. The day before the test the hospital called to say the prior authorization had not been received. My daughter passed away the day before we were supposed to go for the rescheduled test.

– Kathy M.
Now the surgery to remove the thyroid, 2 masses, 14 lymph nodes, and a parathyroid has been denied, pending questionable medical necessity.
– Megan T.
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My 8-year-old had 2 large masses on the thyroid. It took a month and a half to finally get the approval and paperwork sent to the hospital. We had our first appointment and then 5 days later a biopsy that took hours and hours on the phone to get the prior authorization. Then the results came back cancerous. After hours and hours of phone calls after meeting with the surgeons, surgery was scheduled after the prior authorization was received. Now the surgery to remove the thyroid, 2 masses, 14 lymph nodes, and a parathyroid has been denied, pending questionable medical necessity. More info has been sent in and still is kicking back denied. Results from the removed items - cancer.

– Megan T.
My health insurance kept denying me authorizations for scans that would help my doctor perform surgery.
– Linda L.
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My health insurance kept denying me authorizations for scans that would help my doctor perform surgery on a known spinal cord compression at the C-4 level on my spine. I have metastatic breast cancer that was just being diagnosed at that time. Despite peer to peer and numerous requests I finally had to threaten legal action to the insurer. I finally got a PET scan the insurance was stalling on. By the time I had surgery the tumor involved was not just C-4 but C-3 and C-5 as well. I had to have a much bigger surgery than if everything had proceeded the way my doctor would have liked it.

– Linda L.
My son had to go days without medications because they needed 'prior authorization' even though the neurologist started him on them while he was admitted due to having 100+ seizures a day.
– Ariana S.
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I had to go through prior authorization for a couple of my son’s seizure meds. He had to go days without because they needed "prior authorization" even though the neurologist started him on them while he was admitted due to having 100+ seizures a day.

– Ariana S.
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