Patients and Physicians Speak Out

On top of having to live with chronic pain, my patient had to endure acute pain without additional pharmacological support because Medicare wouldn't approve the appropriate (and safe) pain prescription. The patient cared for himself and used his street connections to (unsafely) treat his pain.

As a country, we take pride in medical innovation. We say that the value of our system is the new procedures or medications we create. But I don’t think I’ve ever successfully prescribed these medications to the patients who need them. I’m early in my career and every time I’ve tried, I’ve encountered paperwork like prior authorizations. As a new physician, this can be a nearly unsurmountable barrier. No one teaches you how to complete these forms. This is a major barrier to care for my patients, and a major disservice to medicine as a whole because it prevents us from progressing. When we can’t use the medications that we have available, we’re letting our patients down and wasting the resources we have available.

I’ve wanted to be a primary care doctor for as long as I can remember. The reason being, I didn’t feel like my family had a quarterback who was directing our care, preventing illnesses we didn’t see coming and mitigating the burdens of diseases that already were at work. The single most frustrating issue I have faced as a primary care physician, that constantly makes me second guess my dreams, is the [prior authorization] PA issue. I have young children with type 2 diabetes who have made so many healthy changes but have to keep taking insulin daily because they can’t get a once-weekly medication. I have reproductive aged women who worry about their fertility and future health because they are not able to lose weight and I can’t offer them an evidence-based, FDA-approved medication to assist them because Medicaid has just made access to GLP-1’s [glucagon-like peptide-1] for a weight loss indication non-negotiable. I feel helpless. I feel like I can’t do what I was trained to do because of the insurmountable, unnecessary barriers PA’s pose. Please help me help my patients. These medications will save money in the future by reducing the costs of heart failure admissions, necrotic diabetic foot admissions & ICU admissions for hypertensive emergency. Trust me.

I am a resident physician in Baltimore who takes care of adults and children. I wrote a prescription for a patient upon discharge to continue two important medicines that were started by an inpatient specialist while he was admitted to the hospital for over two months. I received two prior authorizations for these medicines requesting additional documentation for these medicines that he had been on for at least a month. This delayed him getting these medicines refilled, causing his parents to stretch the quantity of medicine they had and give him less than he needed. He was finally able to get the medicines after multiple physicians and other staff worked on it for over multiple hours. The system needs to be changed to allow patients to get timely and necessary care.

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.