Patients and Physicians Speak Out

I’m an RN in CA and recently resigned from my last job as a case manager because I was fed up with how health plans rob their members from needed services by very defined tactics to deny prior authorizations. 7 years of watching three insurances do this is so sickening!!!

I work in oncology, account receivables and prior authorization. It is heinous work. Treatment is OFTEN delayed while waiting for prior authorization. Honestly... why the eff do you need prior authorization for CHEMOTHERAPY? It's not elective!

I work doing authorizations for a hospital and physicians' network that has 2 acute care facilities and at least 100+ physicians. I’ve had patients whose care has been delayed for 3+ months because of incompetence on the part of the insurance company. They don’t read the documentation sent, or they aren’t even properly aware of their own medical guidelines.

I work in healthcare and prior authorization is the biggest waste of time and money. As it’s been said, they have a person sitting in a cubicle somewhere who doesn’t know you, who has never met you, determining if you need the testing, procedure or medication your doctor has ordered. A doctor’s office has to provide chart notes and CPT and ICD10 codes. This can take days and sometimes weeks and sometimes an appeal before an authorization is given. Ironically, after all this time wasted and patients waiting sometimes in pain or worry about a lump/tumor/cyst....the insurance company states that prior authorization doesn't guarantee payment and benefits are determined when the claim is received. So by their own words prior authorization is meaningless yet without it they won’t pay. Prior authorization is supposed to prevent unnecessary treatment which by the way still happens in spite of this rule. . . . There is entirely too much power given to insurance companies and pharmaceutical companies as well. These huge corporations are bonus driven....whenever a company is for-profit and bonus driven, the best interest isn't for those they work for; they only watch out for themselves. It’s not about patients...we are just a # to them....it’s the bonus that matters. We need insurance to pay for the services we need...quit raising premiums and giving us less coverage!! Deductibles and out of pocket and even copays have gone up.

I have spent hours and hours getting prior authorizations. Many patients just give up. Sometimes patients have to suffer and show they tried a lesser med and failed before the med originally recommended is covered. So meanwhile the patient suffers the symptoms while they are forced to do their trial of cheaper med. Terrible care and really disgusting that a physician has no say over his patients.

I have a family history of death from breast cancer, from my birth mother. For 20 years I barely dodged breast cancer, and now I was growing 2 masses a year. Doctor wanted to do the BRCA genetic testing to find out if I carry the genetic factor for breast cancer— denied. My insurance would cover total mastectomies with reconstruction, but they would only allow and pay for 23 hours from start of the surgery, spending the night to discharge. Since my husband and I are retired and will be RVing, we chose bilateral mastectomies, prophylactically, no implants. Done with some clipboard cutesy deciding my life and future.