Your prior authorization stories matter

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

Prior authorization significantly interferes with patient care.
– Dr. Emilio G., Texas
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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., Texas
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., Arizona
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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., Arizona
5 months later waiting to see doctor to get papers filed for prior authorization to get a surgery, which everyone knew was needed originally.
– Cindy J.
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1. I went to a pain clinic for steroid injection in my back but the doctor wanted an MRI first. Insurance says no MRI since there was one done about 2 years prior. Doctor filed appeal but still no and then he wouldn’t do injection because there was no MRI.
2. My husband has several bad discs and severe spinal compression. Doctor said insurance company won’t authorize until he gets physical therapy and a steroid injection, although the doctor said it won’t help. 5 months later we’re waiting to see the doctor to get papers filed for prior authorization to get a surgery, which everyone knew was needed originally. In the meantime, he can’t work and we are paying COBRA insurance.

– Cindy J.
Sometimes patients have to suffer and show they tried a lesser med and failed before the med originally recommended is covered.
– Karen C., Minnesota
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I have spent hours and hours getting prior authorizations. Many patients just give up. Sometimes patients have to suffer and show they tried a lesser med and failed before the med originally recommended is covered. So meanwhile the patient suffers the symptoms while they are forced to do their trial of cheaper med. Terrible care and really disgusting that a physician has no say over his patients.

– Karen C., Minnesota
It is time consuming, frustrating for doctor and patient, and of no clinical benefit.
– Dr. Paul P., Maine
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It is time consuming, frustrating for doctor and patient, and of no clinical benefit.

– Dr. Paul P., Maine
I have heard from many many excellent physicians that this is the main driving force behind physicians' consideration of early retirement, and that includes myself.
– Dr. Vinod S., Illinois
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I feel that prior-auth has been one of the worst things to affect physicians' lives, along with Medicare and insurance companies' constant assault on physicians’ ability to do the right thing in the most efficient manner for their patients. This is all labelled as "monitoring" so that patients are getting proper care. It is a huge wastage of resources. One can write a big dossier about everyday examples of this. I have heard from many many excellent physicians that this is the main driving force behind physicians' consideration of early retirement, and that includes myself.  

– Dr. Vinod S., Illinois
We actually have prior authorizations pending with a total of 119 pages.
– Dr. Rajat D., New Jersey
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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., New Jersey
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., Virginia
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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., Virginia
My experience with prior authorizations, like that of so many Americans, has been horrendous to say the least.
– Lilly H., Ohio
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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., Ohio
I am deaf and prior authorization is an additional barrier to me receiving prescriptions for my health and mental wellness.
– Candace M., Georgia
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I am deaf and prior authorization is an additional barrier to me receiving prescriptions for my health and mental wellness. Calling back doctors’ offices and playing phone tag is downright difficult for me, and my average time depending on the office is several days to two weeks in correcting the matter. I also switched insurance, and many of my medications I was already taking and doing well on required prior authorization when I went to refill. I had issues with missing doses. This feels like insurance companies practicing medicine without a license.

– Candace M., Georgia
I waited 4 months for a prescription.
– Samantha R., California
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I waited 4 months for a prescription of budesonide for treatment of microscopic lymphocytic colitis (uncontrollable diarrhea). Twice.

– Samantha R., California
We have patients who have paid insurance for years, need spine surgery for pain, and because they don't meet criteria they are denied.
– Dr. Randall P., Arizona
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We have patients who have paid insurance for years, need spine surgery for pain, and because they don't meet criteria they are denied.

– Dr. Randall P., Arizona
Yes! I had 3 doctors who wanted to file a class action suit against [my insurer] for playing doctor - they refused almost every script I tried to fill…
– @network_gal, Florida
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Yes! I had 3 doctors who wanted to file a class action suit against [my insurer] for playing doctor - they refused almost every script I tried to fill…

– @network_gal, Florida
My hubby waited four weeks for an okay for heart surgery.
– @midwestusa, Wisconsin
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No kidding. My hubby waited four weeks for an okay for heart surgery.

 

– @midwestusa, Wisconsin
My insurance company approved partial knee replacement surgery. . . [yet] I was left with a $70,000 bill I never would have elected.
– Elizabeth C., Kentucky
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My insurance company approved partial knee replacement surgery. The hospital wouldn't even consider it without prior authorization. Six months later, the hospital called to warn me - the insurer wasn't paying. Denied. I was left with a $70,000 bill I never would have elected.The hospital wouldn't even consider it without prior authorization. Six months later, the hospital called to warn me - the insurer wasn't paying. Denied. I was left with a $70,000 bill I never would have elected.

– Elizabeth C., Kentucky
[My mother] was unnecessarily violently ill for 3 days just due to a prior authorization; it is ridiculous.
– Diana G., Florida
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My mother had pancreatic cancer and underwent the Whipple procedure during her extensive chemo. They recommended she get Marinol due to her violent episodes with vomiting and nausea and nothing was working. During one such episode she went to the emergency room and the attending physician gave her a prescription. It took 3 days to get the prescription filled. In the meantime, she was vomiting and extremely nauseated for over 72 hours because it needed prior-authorization. She was unnecessarily violently ill for 3 days just due to a prior authorization; it is ridiculous. The doctors are overwhelmed, and it serves no purpose. The insurance company would kick it back time and time again.

– Diana G., Florida
I've been denied a treatment that worked for 11 years.
– Gina F., New York
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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., New York
My health insurance kept denying me authorizations for scans that would help my doctor perform surgery.
– Linda L., Texas
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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., Texas
[Prior authorizations are] a f***ing waste of time and resources for both providers and coverage entities.
– Deyvi A.
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I have yet to have a single insurance successfully deny a procedure or diagnostic for a patient (though I have had to appeal them, and some of them are needlessly convoluted). They're a f***ing waste of time and resources for both providers and coverage entities.

– Deyvi A.
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., Arizona
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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., Arizona
[Insurance companies] even reject antibiotics that are free at local pharmacies. It is absurd and wasteful and harmful.
– Dr. Richard L., Florida
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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., Florida
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., Missouri
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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., Missouri
I have to do a prior authorization every time to get liquid antibiotics.
– Kimberly H., New Mexico
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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., New Mexico
I’m an RN in CA and recently resigned from my last job as a case manager because I was fed up with how health plans rob their members from needed services by very defined tactics to deny prior authorizations.
– @MaruriClaudia, California
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I’m an RN in CA and recently resigned from my last job as a case manager because I was fed up with how health plans rob their members from needed services by very defined tactics to deny prior authorizations. 7 years of watching three insurances do this is so sickening!!!

– @MaruriClaudia, California
[Prior Authorization] is one of the worst things to occur to the non-surgical practice of medicine.
– Dr. Seth F., Florida
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I have one employee entirely devoted to prior authorizations appeals and setting up peer-to-peer appointments.  It is one of the worst things to occur to the non-surgical practice of medicine.

– Dr. Seth F., Florida
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., Washington
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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., Washington
I work in healthcare, the prior auth process is very cumbersome. Despite laws prohibiting cancellation or rescinding an auth, carriers do not adhere to these rules.
– Sheila M., Connecticut
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I work in health care, the prior authorization process is very cumbersome. Despite laws prohibiting cancellation or rescinding an auth, carriers do not adhere to these rules. Claims are denied many times in error. Trying to get a prior auth for an unlisted code is even worse. 

– Sheila M., Connecticut
1 lousy MRI and a visit to a neurologist would’ve saved me 10 years of agony and a $300,000 surgery.
– @maigreym
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1 lousy MRI and a visit to a neurologist would’ve saved me 10 years of agony and a $300,000 surgery. Insurance company shareholders are dumb as a box of rocks to put up with that.

– @maigreym
My insurer makes me fight for every prescription.
– @rem3276, Michigan
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My insurer makes me fight for every prescription. And, many times, they do it for prescriptions that I have taken for many years. What insurers really want is for us to give up and pay for them out of our own pocket.

– @rem3276, Michigan
Took 3 weeks to get my chemo pill approved.
– Dawn C.
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Really, my doctor wanted me to do hormone shots with my chemo but [the insurer] refused, so we had to go on a hormone pill instead. Took 3 weeks to get my chemo pill approved… the shots probably would have been more potent.

– Dawn C.
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., New York
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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., New York
My prior authorization story from hell. I've been on the same med since 2017. Every time I go to get it refilled they always need a prior authorization.
– Beth B., West Virginia
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My prior authorization story from hell involves my Voltaren gel for the osteoarthritis in my knees. I've been on the same med since 2017. Every time I go to get it refilled they always need a prior authorization. It never fails. I don't understand why they would need a prior authorization.

– Beth B., West Virginia
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., Hawaii
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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., Hawaii
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., Georgia
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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., Georgia
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., Connecticut
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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., Connecticut
Was denied injections for pain in my back, lost my job without them.
– Katie M., Kentucky
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I was denied injections for pain in my back, lost my job without them. Finally got surgery 8 months later. Had to do PT while I had L5 slipped out over S1 and 3 places of stenosis and a nerve cyst. I was almost reduced to crawling by time of surgery.

– Katie M., Kentucky
They have some damn nerve acting against doctors' wishes for their patients!
– Kathleen G., New York
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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., New York
I save applying for prior authorizations until the end of the day to keep me from swearing out loud when there are patients around.
– Donna C., Arkansas
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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!!)

– Donna C., Arkansas
I have seen patients not able to get their Depo-Provera shots in time due to need for prior authorization.
– Dr. Gina C., Colorado
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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., Colorado
Why do insurance companies have more power over our health than us and our doctors?
– Ellyn W., Missouri
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Why do insurance companies have more power over our health than us and our doctors?

– Ellyn W., Missouri
I recently spent over 10 hours trying to get a patient's surgery authorized.
– Kathy D., Colorado
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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., Colorado
Last month we were denied a routine checkup and EEG because our insurance changed her doctor to ’out of network'.
– Emily R., Maine
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My daughter was diagnosed with refractory generalized epilepsy by the neurologist she has been going to for 13 years. Last month we were denied a routine checkup and EEG because our insurance changed her doctor to "out of network". They expect my daughter to reestablish care with a new "in network" neurologist. When I appealed they denied it because my daughter is currently in remission. It has been VERY frustrating! I can't wait to get my new insurance plan next month!! Hopefully she can get the appointment she needs with the neurologist who knows her history and who has successfully managed her seizures! The system is BROKEN and harmful and way TOO expensive! Uggh!

– Emily R., Maine
[The insurer] had no idea what the drug was for. They were just working off an algorithm.
– Sue F., California
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As a nurse I would spend 30 minutes or more on prior authorizations. The insurance companies would expect doctors to do these calls!  I would often call the insurance company to speak to a prior auth agent who obviously was not medically trained. They could not even correctly pronounce the medication name! They had no idea what the drug was for. They were just working off an algorithm. Try telling them a complicated reason why this patient must have this med...not gonna happen. In my opinion, this is all a way to prevent patients from getting drugs they need. Basically, some uneducated prior auth agent gets to nix a physician order!!!

– Sue F., California
The prior authorization process is broken and needs to be overhauled.
– Sheila M., Connecticut
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I work in healthcare. Providers are jumping through too many hoops, at great financial cost, to be able to provide clinically appropriate and medically necessary treatment for their patients. We get a prior authorization, only to have our claims be denied for "no auth." Healthcare decisions should be left to the clinician, not the insurance carrier. The prior authorization process is broken and needs to be overhauled.

– Sheila M., Connecticut
After the MRI I had to wait 2 more weeks for approval. From start to finish I was laid up 4 months and even lost my job because I ran out of FMLA.
– D'anna H., Iowa
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Yes, just last year I needed knee surgery. The insurance made me go thru 2 weeks of resting it then 3 weeks of physical therapy plus a fluid removal attempt. All this before I could even get an MRI that my ortho doc with 40 yrs experience knew I needed in the first place. After the MRI I had to wait 2 more weeks for approval. From start to finish I was laid up 4 months and even lost my job because I ran out of FMLA. Now I have a wrist injury and I am not going for treatment because I really like my new job and I am afraid to go thru it all again.

– D'anna H., Iowa
[My sister] broke her ankles and the insurance company has denied every request her doctor has made for every test. She is now unable to walk.
– Sue Ann H., Ohio
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Just another means for insurance companies to save money by preventing our doctors from prescribing the care needed. (Or delaying it so death comes first). My sister was fine until she tripped during a nighttime visit to the bathroom. She broke her ankles and the insurance company has denied every request her doctor has made for every test. She is now unable to walk.

– Sue Ann H., Ohio
These prior authorizations are putting people at high unnecessary health risks. Please help to put a stop to this method.
– Cindy H., Texas
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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., Texas
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.
– Sherrie 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.

– Sherrie H.
I worked for the largest PBM around. I have many heartbreaking stories.
– Brenda F., Ohio
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I worked for the largest PBM around. I have many heartbreaking stories.

– Brenda F., Ohio
[My staff] spend so much time with prior authorizations and insurance issues that we struggle to answer the phone when a patient calls.
– Dr. Roscoe N., Arizona
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I have 6 full time and 1 part time staff to support 1 physician and 1 physician assistant. They spend so much time with PA's and insurance issues that we struggle to answer the phone when a patient calls. It leads to frustration on everyone's part. It's getting worse, please help!

– Dr. Roscoe N., Arizona
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., Pennsylvania
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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., Pennsylvania
. . . they wouldn’t authorize [my sweetheart’s] meds in time so his current prescription ran out and we had to go to the hospital for pain control. They are heartless!!
– Lisa R., Arizona
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This happened to my sweetheart, changing insurance companies. He was on pain meds for an extended period and they wouldn’t authorize his meds in time so his current prescription ran out and we had to go to the hospital for pain control. They are heartless!!

– Lisa R., Arizona
Prior authorization delays treatment, prolongs pain and cuts vital treatment short or off.
– Rae S., Georgia
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I am a Geriatric Social Worker in a senior residence. Prior authorization delays treatment, prolongs pain and cuts vital treatment short or off. These delays cost us all when Medicare and Medicaid patients use the ER post hospital or rehab discharge or while awaiting insurance approval for a procedure.

– Rae S., Georgia
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., South Carolina
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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., South Carolina
I waited 6 days to get approved for Fentanyl patches for my cancer.
– Cozetta C., Michigan
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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., Michigan
Would no longer authorize same injection meds to knees I had been getting for years and had to settle with some half-ass stuff that didn’t even work.
– Barglen C., Texas
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You cannot get the cost of a procedure before you get it. What was supposed to be $157 out of pocket after meeting deductible turned into $900! [My health insurer] would no longer authorize the same injection meds to knees I had been getting for years and had to settle with some half-ass stuff that didn’t even work. I need to know if I can afford something before I go in and do it - not a guesstimate! $157 turns into $900!

– Barglen C., Texas
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., Tennessee
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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., Tennessee
I went almost two weeks without long-acting insulin and 2 days without even short-acting insulin waiting for prior authorizations. This landed me in the ER 3 times and sent me into a pancreatitis flare.
– Kimberly S., Pennsylvania
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I went almost two weeks without long-acting insulin and 2 days without even short-acting insulin waiting for prior authorizations. This landed me in the ER 3 times and sent me into a pancreatitis flare. And wasted about 3 hours of my doctor’s time to get insulin. This was not new either; I have been diabetic since I was a kid, so about 25 years. They also made me switch what kind I use, and that caused my sugar to be out of control for weeks, even after I finally got the insulin, while I determined my correct bolus dose of the new insulin.

– Kimberly S., Pennsylvania
The red tape I go through is insane, especially to obtain my breast MRI each spring that's ordered by my breast surgeon.
– Jane M., Illinois
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I'm a breast cancer survivor. I live in a rural area in southern Illinois.The red tape I go through is insane, especially to obtain my breast MRI each spring that's ordered by my breast surgeon. It scares me because if my cancer does return, I want to be able to begin treatment as soon as possible, without waiting to wade through a bureaucratic mess.

– Jane M., Illinois
We haven't been able to provide at least 6 different medications to our clients due to the need for prior authorization.
– Kimberly G., Florida
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I work in a 24-bed Intermediate Care Facility for Individuals with Intellectual Disabilities. We haven't been able to provide at least 6 different medications to our clients due to the need for prior authorization. There are 9 medications that we got from our pharmacy, but may have to pay for as a facility pending prior authorization. These are not expensive medications for the most part and are essential for our clients' quality of life!

– Kimberly G., Florida
This nonsensical waste of time has got to stop!
– Dr. William L.
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We treat severe asthmatics, Primary Immune Immunodeficiency and a rare genetic disorder, HAE. All of the medications for these patients require hours of prior authorization work. I have a full time physician assistant who spends 40-50% of her time addressing these. Beyond these requests we now are required to spend time preapproving commonly prescribed and inexpensive medications for almost every patient we see. We are also seeing prior authorization requests on common procedures which does not allow us to complete needed treatment at the time of the visit. This nonsensical waste of time has got to stop!

– Dr. William L.
How can [insurers] give us all the accountability, but no authority?
– Dr. M. B., Ohio
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So after 20 years of practice, Board Certified, MOC'd, actually caring for the patient, deciding on best care alternatives, why would ANYone interfere with that? You deny my request, fine, you have NOW taken over the care and treatment of the patient, with all the responsibilities of that care. How can you give us all the accountability, but no authority? This must change.

– Dr. M. B., Ohio
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., Georgia
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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., Georgia
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., Washington
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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., Washington
It took three days to get an $8 prescription of generic Celebrex.
– @droll3
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It took three days to get an $8 prescription of generic Celebrex [anti-inflammatory drug], that I needed at home immediately after knee replacement surgery. My insurer demanded three different authorizations from my surgeon because it wasn’t in their formulary. The opiate was immediately dispensed. I was mad!

– @droll3
[Prior authorization is] leaving patients with severe depression and hallucinations untreated with delays ranging from days to weeks.
– Dr. Heather V., Florida
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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., Florida
I need prior auth for my continuous glucose monitor every time I get sensors for it- this device alone has saved my life more times than I can count, yet the insurer thinks it isn’t a necessity!
– @KronikerD
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I need prior auth for my continuous glucose monitor every time I get sensors for it- this device alone has saved my life more times than I can count, yet the insurer thinks it isn’t a necessity!

– @KronikerD
Why would they [deny] this medication [that] is old school and inexpensive?!
– @DiPaulo99
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I just experienced my [health plan] denying me a prescription non-steroidal anti-inflammatory that I have been prescribed in the recent past, i.e., two years! Why would they do such a thing? This medication is old school and inexpensive?!

– @DiPaulo99
Patients requiring imaging studies in order to determine a treatment plan are not receiving appropriate care due to delays caused by prior authorization.
– Mimi T., Indiana
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Post-op patients are going home without pain meds due to prior authorization. Patients requiring imaging studies in order to determine a treatment plan are not receiving appropriate care due to delays caused by prior authorization.

– Mimi T., Indiana
I told the idiot on the other end of the phone that if 6 weeks of physical therapy could cure lung cancer, we would have a miracle on our hands.
– Dr. Tamara P., Pennsylvania
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I had a patient in her late forties who had been a smoker since her early teens. She came in with hemoptysis and shortness of breath. A chest x-ray revealed a single 2 cm nodule in her left upper lung field. I wanted to get a CT of the chest to better characterize this as it was most likely lung cancer. The response from the insurance company was she could not have a CT scan until she had first undergone six weeks of physical therapy. Yes, you read that right. Physical therapy. I told the idiot on the other end of the phone that if 6 weeks of physical therapy could cure lung cancer, we would have a miracle on our hands. It still took three more phone calls and faxing over office notes before I could get the CT scan approved. It took almost 2 weeks.

– Dr. Tamara P., Pennsylvania
I was denied prior auth for a urological med that we knew worked for me.
– Elle H., Kansas
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I was denied prior auth for a urological med that we knew worked for me. [My insurer] would not pay until I had tried a different drug, and it turned out I had an allergy to it. I lost my insurance before I could appeal.

– Elle H., Kansas
Despite being on this lifelong medication for over eight years, I still need a prior auth completed yearly which generally results in a period of time without the medication.
– Kellie M., Florida
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Due to a medication I take needing prior auth, I have at times been without the medication. I have had the medication denied, leaving me without it for over a month, to then get approved after excess paperwork was submitted by my physician. Despite being on this lifelong medication for over eight years, I still need a prior auth completed yearly which generally results in a period of time without the medication.

– Kellie M., Florida
I am one case out of hundreds that my surgeon has to spend hours upon hours needlessly playing phone tag.
– Eva T., California
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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., California
Ironically, after all this time wasted and patients waiting sometimes in pain or worry about a lump/tumor/cyst....the insurance company states that prior authorization doesn't guarantee payment and benefits are determined when a claim is received.
– Linda J., Utah
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I work in healthcare and prior authorization is the biggest waste of time and money. As it’s been said, they have a person sitting in a cubicle somewhere who doesn’t know you, who has never met you, determining if you need the testing, procedure or medication your doctor has ordered. A doctor’s office has to provide chart notes and CPT and ICD10 codes. This can take days and sometimes weeks and sometimes an appeal before an authorization is given. Ironically, after all this time wasted and patients waiting sometimes in pain or worry about a lump/tumor/cyst....the insurance company states that prior authorization doesn't guarantee payment and benefits are determined when a claim is received. So by their own words prior authorization is meaningless yet without it they won’t pay. Prior authorization is supposed to prevent unnecessary treatment which by the way still happens in spite of this rule. . . . There is entirely too much power given to insurance companies and pharmaceutical companies as well. These huge corporations are bonus driven....whenever a company is for-profit and bonus driven, the best interest isn't for those they work for; they only watch out for themselves. It’s not about patients...we are just a # to them....it’s the bonus that matters. We need insurance to pay for the services we need...quit raising premiums and giving us less coverage!! Deductibles and out of pocket and even copays have gone up.

– Linda J., Utah
I recently had a patient die due to needing a prior authorization for cefpodoxime axetil for a UTI.
– Dr. Philip K., Arizona
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I recently had a patient die due to needing a prior authorization for cefpodoxime axetil for a UTI.

– Dr. Philip K., Arizona
You may have to argue with an insurance worker who is looking at a chart and knows NOTHING about medical care.
– @A2Pirana, Illinois
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And then you may have to argue with an insurance worker who is looking at a chart and knows NOTHING about medical care. I know, I was a medical office manager. I had to go to supervisors and argue my case why a patient needed a procedure.

– @A2Pirana, Illinois
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., Pennsylvania
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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., Pennsylvania
Now the surgery to remove the thyroid, 2 masses, 14 lymph nodes, and a parathyroid has been denied, pending questionable medical necessity.
– Megan T., Texas
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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., Texas
How corrupt is the chain of command when a doctor orders an MRI and the insurance denies the order?
– Sharyn O., Florida
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How corrupt is the chain of command when a doctor orders an MRI and the insurance denies the order? This applies to surgeries, lab, physical therapy, meds etc.

– Sharyn O., Florida
I don’t think my son’s medical specialists should be second guessed and overridden by an insurance company.
– Lisa W., Nevada
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My children have [a health plan] which required prior authorizations excessively and has resulted in my children going without needed medication which they had a history of taking previously. My 15-yr-old then spent 48 days inpatient between 4 hospitals due to a serious neurological condition. On two occasions, he was denied medication prescribed by his specialists. I could not afford to pay out of pocket so he went without needed medication. I don’t think my son’s medical specialists should be second guessed and overridden by an insurance company.

– Lisa W., Nevada
Still trying to get a diabetes med that works for me but [my health plan] is being a complete pain about it!!!
– Kim H., Ohio
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It has and it makes me very angry! Still trying to get a diabetes med that works for me but [my health plan] is being a complete pain about it!!!

– Kim H., Ohio
As a former Hospital Case Manager, it was very common for patients to be forced to remain in the hospital three extra days, while we waited on the insurance companies to review the chart and give authorization for discharge plans.
– @TootieIB, Texas
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As a former Hospital Case Manager, it was very common for patients to be forced to remain in the hospital three extra days, while we waited on the insurance companies to review the chart and give authorization for discharge plans.

– @TootieIB, Texas
Prior authorization was very detrimental to a very close friend of mine.
– Becca N.H., Texas
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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 Catapres 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 Catapres 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., Texas
My husband went without blood thinners for two months because we switched insurance carriers (because I switched jobs and had no choice).
– Deb C., Illinois
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Yes. My husband went without blood thinners for two months because we switched insurance carriers (because I switched jobs and had no choice). He could have had a stroke or pulmonary embolism, but the insurance company doesn’t care!

– Deb C., Illinois
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., Indiana
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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., Indiana
The insurance company hasn't authorized them yet so they come to the ED to get a CT.
– Beverly Kay W., Kentucky
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I am an ED RN. I frequently see patients who have seen their family doctor and have a CT ordered. The insurance company hasn't authorized them yet so they come to the ED to get a CT. Sometimes they come on their own, sometimes the doctor sends them, so they can get the test in a timely manner.

– Beverly Kay W., Kentucky
I have a patient with a crush injury to his foot who waited 2 months for appropriate imaging studies and then SIX months for approval to operate.
– Dr. Vito R., New York
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I have a patient with a crush injury to his foot who waited 2 months for appropriate imaging studies and then SIX months for approval to operate. Tell me our system is the best. Please. I have many examples. Everyday.

– Dr. Vito R., New York
Never have I encountered a reasonable situation where filling out a prior authorization was important either for the patient or myself.
– Dr. Kartik K., Illinois
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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., Illinois
Physicians and patients get caught in the crossfire of endless forms and calls while waiting for meds, which they have successfully taken for years, are now questioned.
– Dr. Peter S., Pennsylvania
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It is not uncommon for patients to change pharmacy benefit managers when changing health plans or for health plans to change their pharmacy benefit manager.  Physicians and patients get caught in the crossfire of endless forms and calls while waiting for meds, which they have successfully taken for years, are now questioned.  It is very difficult to reconstruct a person's previous med history when we have changed to a new EMR and then find it hard to justify to the PBM why the person ended up on the regimen that is working for them.  It is a waste of time and potentially dangerous.  These requests involve FDA-approved drugs and often generic medications.

– Dr. Peter S., Pennsylvania
[The health plan] refused emergency room service. We had to wait until the next day to get authorization to take her to the ER for x-rays.
– Valerie B., Ohio
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My daughter had a fractured ankle....[the health plan] refused emergency room service. We had to wait until the next day to get authorization to take her to the ER for x-rays. By then, it was so badly swollen, they could only soft cast it to stabilize it. She was in a cast for another 3 months.

– Valerie B., Ohio
It took me about 3 months to get back on track with my [ulcerative colitis] remission.
– Maureen R., North Carolina
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I take Humira for ulcerative colitis. Last year I had to get prior authorization to continue taking it. It took SIX WEEKS of back and forth with the health plan and my provider. I had to get my employer involved. The health plan out-sourced the specialty drugs and pointed fingers between them and the company as to who was demanding the documentation. It took me about 3 months to get back on track with my remission.

– Maureen R., North Carolina
Lidocaine patches are the only thing that eases the pain but the insurance company won’t cover them without prior authorization. . . what am I left with for the pain? Absolutely nothing.
– Nadine G., Michigan
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The problem for me is getting the prescriptions that I need. I have a back injury that I had surgery for but still have issues with pain, mostly sciatica. My doctor won’t write for narcotics, Tylenol doesn’t help and I can’t take anti-inflammatory meds due to being on blood thinners and having already had a GI bleed. Lidocaine patches are the only thing that eases the pain, but the insurance company won’t cover them without prior authorization and because I don’t have diabetic neuropathy or shingles. Go figure! So now what am I left with for the pain? Absolutely nothing. Why can’t they just use common sense?

– Nadine G., Michigan
One day my doctor tried [to obtain prior authorization] and his staff spent 6 hours on the phone for one patient.
– @lt_temple, Arizona
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If my insurance wants a prior authorization, forget it, it will not happen. One day my doctor tried and his staff spent 6 hours on the phone for one patient. No one has that kind of time. PRIOR AUTHORIZATION MUST BE FIXED!

– @lt_temple, Arizona
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., Colorado
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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., Colorado
It took me a month just to get a blood glucose meter because of 'prior authorization.'
– Steven Y., Florida
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It took me a month just to get a blood glucose meter because of 'prior authorization.'

– Steven Y., Florida
Prior authorizations are the hidden additional cost of delivering healthcare.
– Dr. Joseph T., South Carolina
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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.

– Dr. Joseph T., South Carolina
Honestly... why the eff do you need prior authorization for CHEMOTHERAPY? It's not elective!
– Suzanne D., California
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I work in oncology, account receivables and prior authorization. It is heinous work. Treatment is OFTEN delayed while waiting for prior authorization. Honestly... why the eff do you need prior authorization for CHEMOTHERAPY? It's not elective!

– Suzanne D., California
My insurer required me to try another drug at a huge co-pay to me before they would consider filling my prescription.
– Cathy M., Nevada
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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., Nevada
[Prior authorization] shackles my ability to help get the medications my patients need.
– Dr. Jesse V., Michigan
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[Prior authorization] shackles my ability to help get the medications my patients need. I have had countless instances where patients have had worsening disease because of the delay and inadequacies of the current PA system.

– Dr. Jesse V., Michigan
I had to wait for a month for my insurance to approve an MRI when I broke my shoulder.
– Cheri N.
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I had to wait for a month for my insurance to approve an MRI when I broke my shoulder.

– Cheri N.
Couldn't get my new diabetes Rx when the doctor changed medicines without prior authorization and that took 10 days to get it.
– Ann J., Arkansas
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Couldn't get my new diabetes Rx when the doctor changed medicines without prior authorization and that took 10 days to get it.

– Ann J., Arkansas
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., New York
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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., New York
If we try to do the work ourselves, our limited staff is taken away from patient care for 30-45 minutes with each incident. Prior authorization directly devalues the doctor-patient relationship.
– Dr. Winslow M., Texas
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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. Prior authorization 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. Winslow M., Texas
Could not get a BiPAP machine without approval just last month.
– Louise D., Ohio
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Could not get a BiPAP machine without approval just last month.

– Louise D., Ohio
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.
– Susanna L., New York
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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.

– Susanna L., New York
Every time [my daughter] needed antibiotics, her doctor gave me samples because the insurance company took 10 days.
– Sarah H., California
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My daughter is allergic to amoxicillin and requires another drug. Every time she needed antibiotics, her doctor gave me samples because the insurance company took 10 days.

– Sarah H., California
The pharmacy calls me later and tells me the insurance needs to get this authorized . . . If there had not been a refill on file for the lower dose we would have had a big problem on our hands. I would have had to take him back to the hospital.
– Mj O., New York
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I had a few incidents this year where my son was hospitalized …Took his prescriptions over to the pharmacy after each release. The pharmacy calls me later and tells me the insurance needs to get this authorized . . . The pharmacy was not able to get a hold of the doctor that afternoon. I asked the pharmacist what can we do, he needs the medication and cannot skip it. They look up the cost and it was over $1,400 dollars for a 15 day supply. I didn't have the funds for that. Luckily, there was a refill on a lower dose of that medication on file that had been approved before so all I had to give him was double that dose. When they finally were able to get a hold of the doctor he called the insurance company. If there had not been a refill on file for the lower dose we would have had a big problem on our hands. I would have had to take him back to the hospital.

– Mj O., New York
[Prior authorization] seriously erodes the patient's trust in my knowledge and ability to help them.
– Dr. Michael J., Washington
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I work in a headache clinic. Most of our treatments, at this time, are "off-label." When I prescribe a medication that is denied, the pharmacist tells the patient that I just have to do a prior auth and they can get it. I (and my MA who spends 50% of her time doing this) completes the prior auth, however, the prior auth requires a stratified treatment based on the medication's FDA-approved indication. I explain and even include studies to show the potential benefit for headaches. The prior auth is denied and the information given to the patient, either by the pharmacist or by the patient's insurance rep, is that a) I didn't do the prior auth correctly, or b) it was not the right medication for that patient. Both statements seriously erode the patient's trust in my knowledge and ability to help them.

– Dr. Michael J., Washington
I’ve had patients whose care has been delayed for 3+ months because of incompetence on the part of the insurance company.
– Elizabeth F., Oklahoma
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I work doing authorizations for a hospital and physicians' network that has 2 acute care facilities and at least 100+ physicians. I’ve had patients whose care has been delayed for 3+ months because of incompetence on the part of the insurance company. They don’t read the documentation sent, or they aren’t even properly aware of their own medical guidelines.

– Elizabeth F., Oklahoma
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., Michigan
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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., Michigan
I have a family history of death from breast cancer . . . Doctor wanted to do the BRCA genetic testing to find out if I carry the genetic factor for breast cancer—denied.
– Sharyn O., Florida
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I have a family history of death from breast cancer, from my birth mother. For 20 years I barely dodged breast cancer, and now I was growing 2 masses a year. Doctor wanted to do the BRCA genetic testing to find out if I carry the genetic factor for breast cancer— denied. My insurance would cover total mastectomies with reconstruction, but they would only allow and pay for 23 hours from start of the surgery, spending the night to discharge. Since my husband and I are retired and will be RVing, we chose bilateral mastectomies, prophylactically, no implants. Done with some clipboard cutesy deciding my life and future.

– Sharyn O., Florida
Do I hold my breath while waiting 3 days to breathe with inhalers? It's like a game of chess.
– Joyce W., North Carolina
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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., North Carolina
One of the biggest reasons why I just couldn't practice any longer was prescription prior authorizations.
– Louann W., Pennsylvania
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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!”

– Louann W., Pennsylvania
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., Missouri
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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., Missouri
I have ADD . . . Quite a kicker that I need the drugs to be able to concentrate enough to get through the red tape to get the drug.
– Megan T., Minnesota
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I am on Medicare with an assisted cost plan administered by [my health plan].  I have ADD, inattentive type. Every single psycho-stimulant drug for my treatment requires prior authorization. Every. Single. One. Quite a kicker that I need the drugs to be able to concentrate enough to get through the red tape to get the drug.

– Megan T., Minnesota
Share your story

Have you ever gone to the pharmacy to fill a prescription only to be told that your insurance company requires approval before they'll cover your treatment? Have you ever waited for days, weeks, or months for a test or medical procedure to be scheduled because authorization from an insurer? Or are you a physician frustrated with the administrative headaches and their impact on your patient?

Prior authorization is a burden on patients and physicians alike. The process is confusing, time consuming, and — most importantly — can cause delays in patients receiving the care they need.

Please tell us know how prior authorization has impacted you. We are looking for stories from patients and physicians to highlight and draw attention to this issue that is impacting the health of so many Americans.