Patients and Physicians Speak Out

I am tired and frustrated by insurance companies and their ongoing denials, prior authorizations, and appeals. This is the height of crap they put patients through. As a sleep doctor, I order sleep studies based on patients’ symptoms and to rule out sleep apnea. Snoring is associated with sleep apnea and is one of its symptoms. Allied Benefit denies sleep studies if we use snoring as one of the diagnosis codes. Go figure that. One insurance [company] denied a sleep study since the term “excessive daytime sleepiness” was not used (layman term). Instead, I used hypersomnia, which is the medical term. They also now deny sleep studies and say patients don't have co-morbidities like heart attack or stroke. Treating sleep apnea is part of preventative medicine. One case, I had to call and was surprised by their rejection. When I called, the doctor representing the insurance company asked, “What is his weight?" and “Does he snore?” All these symptoms are already discussed in his clinic note. They don't read our notes. They think that if they deny, at least some doctors won't call for their patients, allowing insurance companies to save money. This is a nasty way to make billions of dollars. I feel so bad for patients who don't get adequate care on time. I myself go through this as a patient. Tizanidine, which I have ordered for patients. I myself couldn't get it, since my insurance won’t pay, and they said it will cost $400 for a few pills. 

I don't know why I went into medicine. After 12 years of education and +5 yrs of PhD work, I have to haggle with these idiots. We get health insurance to cover our health care, not for them to take the money and deny the coverage. This is what is called elite daytime robbery in the name of healthcare. They think doctors make money. Check the salaries of the CEOs and other administrators of the hospitals and insurance companies. At least pay us for education and the debts we accumulated to get here. I wish I took a different route for my career—business administration in the healthcare industry.

I can't get my medication that could potentially save my life and give me peace of mind because of all the wait times for prior authorization. I am a trauma nurse. I know the field. This. Is. Wrong.

I have been fighting this [prior authorization] for years. My doctors and I are frustrated. Every year when my insurance renews two of my medications, they get rejected and they need another prior authorization. If it is the same insurance company, same doctor and I had a prior authorization the year before, why do they need to waste my time? This is medication that I have been on for over ten years and with Anthem for almost just as long. My insurance is not cheap, and I have to spend hours and days fighting to get it approved. The frustration and anxiety take a toll on me. I'm thinking this is not good for my health. They should be paying me at this point. My medication is important, but what about other [patients], which could mean life or death? Would they rather have them go to the emergency room? I don't think that would be cost effective for insurers.

My daughter had a tonsillectomy as an adult (notably more difficult recovery, they say), and the pain medication she needed was not available at the pharmacy because it needed “prior authorization.” The option was to either give me a few days of it and I fight for more, or I pay out of pocket for pain medication POST SURGERY.

I have been battling irritable bowel syndrome with diarrhea (IBS-D) for over 12 years. I’ve had three colonoscopies and one camera that I swallowed, as well as many other tests over the past few years. I went to a new gastroenterologist who looked over my records and said I have IBS-D and prescribed a drug that they claim will take care of this. It has been weeks since the doctor’s office filled out the prior authorization and nothing. I assume it has been denied. I cannot go anywhere far, including work, on certain days. I am debating on going to the emergency department to get some relief. I know this cannot be cost effective for me or the insurance company.

I have two children who have type 1 diabetes. I can’t tell you how many times my oldest son had his insulin or pump supplies denied because they [insurer] needed prior authorization for a medicine that had already been established as necessary for him to stay alive and yet, year after year, they hold up his prescriptions at least once saying they need prior authorization. Do they realize there is no cure, and he will need those medications and supplies forever? My daughter was just recently diagnosed and was dangerously close to going into ketoacidosis. But the insurance company needed prior authorization for a glucose meter and her insulin was held up for 24 hours because the insurance company needed the doctor to call in a prescription of the generic version of insulin, instead of giving the pharmacist or me the option to say, “Yes, I want the generic version.”