Patients and Physicians Speak Out

My daughter had a fractured ankle....[the health plan] refused emergency room service. We had to wait until the next day to get authorization to take her to the ER for x-rays. By then, it was so badly swollen, they could only soft cast it to stabilize it. She was in a cast for another 3 months.

1 lousy MRI and a visit to a neurologist would’ve saved me 10 years of agony and a $300,000 surgery. Insurance company shareholders are dumb as a box of rocks to put up with that.

I went almost two weeks without long-acting insulin and two days without even short-acting insulin waiting for prior authorizations. This landed me in the ER 3 times and sent me into a pancreatitis flare. And wasted about 3 hours of my doctor’s time to get insulin. This was not new either; I have been diabetic since I was a kid, so about 25 years. They also made me switch what kind I use, and that caused my sugar to be out of control for weeks, even after I finally got the insulin, while I determined my correct bolus dose of the new insulin.

My children have [a health plan] which required prior authorizations excessively and has resulted in my children going without needed medication which they had a history of taking previously. My 15-yr-old then spent 48 days inpatient between 4 hospitals due to a serious neurological condition. On two occasions, he was denied medication prescribed by his specialists. I could not afford to pay out of pocket so he went without needed medication. I don’t think my son’s medical specialists should be second guessed and overridden by an insurance company.

My daughter was diagnosed with refractory generalized epilepsy by the neurologist she has been going to for 13 years. Last month we were denied a routine checkup and EEG because our insurance changed her doctor to "out of network". They expect my daughter to reestablish care with a new "in network" neurologist. When I appealed they denied it because my daughter is currently in remission. It has been VERY frustrating! I can't wait to get my new insurance plan next month!! Hopefully she can get the appointment she needs with the neurologist who knows her history and who has successfully managed her seizures! The system is BROKEN and harmful and way TOO expensive! Uggh!

I take Humira for ulcerative colitis. Last year I had to get prior authorization to continue taking it. It took SIX WEEKS of back and forth with the health plan and my provider. I had to get my employer involved. The health plan out-sourced the specialty drugs and pointed fingers between them and the company as to who was demanding the documentation. It took me about 3 months to get back on track with my remission.