Patients and Physicians Speak Out

Prior authorizations routinely delay patients being able to see me and to get radiologic and other studies done in a timely fashion. I am a gyn oncologist, and I have seen patients with cancer wait for months to get an appropriate referral to a gyn oncologist. One recent cancer patient of mine waited 6 months to see 3 physician specialists for surgery. Once she had seen them and set up her surgery, her scan was repeated (she had to wait a month to get this approved also) and she had disease progression and was no longer eligible for surgical cure. This patient was 27 years old. I had to call her and tell her we needed to cancel her surgery. She may never be eligible for curative surgery again. This delay most likely significantly worsened her prognosis and will contribute to a family losing their daughter, wife and mother. This needs to end now.

[Prior authorization is] frustrating, time consuming, NO value added, and delays care and even puts [patients] at risk for life-threatening situations. Utter, utter waste of time and energy.

Just [yesterday], I had a patient that needed a STAT computed tomography angiography (CTA) in whom I suspected pulmonary embolism (PE). But nope! Needed a [prior authorization] — went to review (!) and told us to call after noon. Fortunately, they approved it. Lo and behold- the guy has [bilateral] PEs and ended up in the hospital. There are thousands of such stories all over the country and still not a thing being done about it! Why aren’t insurance companies held responsible? Why aren’t they held accountable AND liable for any bad outcome??

I worked for a surgeon and spent untold hours pre-certifying surgeries, getting approval and a precert number. Then after filing for payment, it would be turned down, another phone call and finally payment sent. This happened all the time. Many insurance companies stall and stall before paying. No wonder doctor bills are high. They have to hire extra people to put up with all this [prior authorization] bulls**t.

I am a doctor but experienced how badly prior authorization affects patients with my daughter’s experience. She was prescribed a very expensive medicine, which is covered by insurance. The medication is required to be filled (picked up) within a week. Our insurance prior authorization process takes longer than a week. Hence, insurance didn’t cover the medication cost. All the insurance company had to do to save money was to slow-walk the process. I paid cash for the medicine with a GoodRX coupon. I live in an impoverished area, and I know that none of my patients’ families could afford to do that.

[Prior authorization affects my practice because] it delays patient care. The process is tedious, and the insurance companies are programmed to deny first. You are on the phone for hours waiting and when you finally reach someone, they often redirect you to another department or team where you have to wait again. The operators don't know or understand the procedure or what the patient needs to authorize something. They also can't answer your questions because they are not clinical. The insurance companies have hard and fast rules that do not take the patient into account. They will still deny procedures even when their own medical experts agree with your assessment and what the patient needs. "If the plan doesn't cover it, then there's nothing they can do." The entire process is burdensome and harms patient care.

I am a 2-person, single physician office. My office administrator is also a clinician with her own caseload. It takes me 20 minutes to complete prior auth documentation at a minimum.

Denials of coverage for meds then takes [my] office admin 30-45 min on the phone to do appeals. I then have to spend more time to pull articles supporting use of the named med in given situations, pulling research on alternative treatments that have been shown to be less effective, etc., in order to provide support to the [prior authorization] appeal. I do not accept insurance, in part because a small office in psychiatry does not have the income to sufficiently support dedicated prior auth staff, insurance billing staff, etc., to deal with insurance loopholes and frustrations.