Patients and Physicians Speak Out

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.

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.