Patients and Physicians Speak Out

We found out our son has asthma after two frightening trips to the emergency room (ER}, followed by days in the hospital when he was four years old. The doctors prescribed Flovent as a maintenance treatment to help keep his airway clear and prevent return trips to the ER when he would get an illness. The first time I tried to pick up this medication I heard of “prior authorization.” I thought, “What does this mean?” The doctor prescribed it, so why does an insurance company get to decide whether it’s required? Luckily, the doctor was able to get it approved quickly. The next time I tried to pick it up, it was the same - why would they need to approve it again for the very same medication? This time, I ended up paying out of pocket because I needed it that day to continue treatment. Over the past two years, he’s been using this [medication] and I’ve been held up at least half a dozen times for prior authorization for the same medicine for the same ailment - it has not changed!! Why does it have to continually get approved? With the new plan year, we may have to move to a different medicine, which is incredibly unfortunate for a young child to have to switch from something that is working to an unknown.

I am currently dealing with a rescinded approval that my insurance company sent me in writing that gave prior authorization for the one medication that provides better quality of life. They had no issues covering it until January 2025 after over four years of paying for my monthly prescription. I am a Medicaid, Medicare patient. On Thursday, they [insurers] sent me another letter denying and taking back the approval, plus they gave me a window of 72 hours in which to appeal. My doctor's office is not available on Friday, Saturday or Sunday, so I don't know what or how to proceed. This is extremely stressful and causes great duress. How can it be legal to approve and deny in writing within a few days?

I was injured in a vehicle accident resulting in debilitating migraines and head, neck, and facial pain from a brain injury. I suffered two years of headaches to “fail” enough treatments for insurance to approve a five-year-old treatment that’s now gold standard for migraine relief. After eight months of success on this medication, my employer switched Rx providers to a company that requires preauthorization and proof that this is the only medication that actually works. Why does Congress allow insurance companies to dictate treatment decisions over doctor’s orders, published evidence, and the patient experience? Why must Americans suffer under this broken system?

I am suffering with severe back and sciatica pain. I have tried many things to avoid surgery: at-home physical therapy (PT), injections and various medications. My surgeon stated surgery was my only hope for relief. Insurance would not authorize it until I went through PT, which only increases my pain. Apparently, they consider [surgery] not medically necessary. I called my insurance company to explain the rest of the medical verbiage in their denial letter. They stated my doctor would have to explain it. What? They don't understand their own denial! Patients suffer.

I went to a pharmacy to pick up my medication to find out that the insurance company was asking for a "prior authorization," after I took the exact same medication for nearly a decade. Due to the insurer needing a prior authorization, I couldn't fill my prescription, and the pharmacy would be closed for the next two days, so I didn't know what to do. I went home to discuss it with family, and we found no other choice but to purchase the medication with cash for $140.00. It's medication that I need to take daily. Now I'm on disability with very limited income, raising my two great nieces. One [of my nieces] is non-verbal autistic. Do you realize what prior authorization has done to our family and finances this month? It means less money to buy and pay for everything across the table, from food to utilities, gas, and more.

 All because of this unnecessary prior authorization stuff, and it's affecting real world people with real lives and real issues, living check to check while raising children. It's disgusting how the insurance companies play with their insured in hopes they can save money by having the patient walk away or pay out of pocket for services, treatment, and/or prescriptions. This year, 2025 makes it the THIRD YEAR that Humana has forced a prior authorization, and I was made to pay cash for my medication. When I tried to get reimbursement from Humana, they refused to pay me back, then they filed a dispute on my behalf with their company and that too was rejected. Humana ultimately sent me a check for $43, which I never cashed because they owe me $150.00, plus $150.00, plus $140.00 now. Can you not see how prior authorization is critically affecting people of all walks of life and most times it's happening when we're at our worst?

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.