Patients and Physicians Speak Out

My insurance company approved partial knee replacement surgery. The hospital wouldn't even consider it without prior authorization. Six months later, the hospital called to warn me - the insurer wasn't paying. Denied. I was left with a $70,000 bill I never would have elected.

I was denied injections for pain in my back, lost my job without them. Finally got surgery 8 months later. Had to do PT while I had L5 slipped out over S1 and 3 places of stenosis and a nerve cyst. I was almost reduced to crawling by time of surgery.

My mother had pancreatic cancer and underwent the Whipple procedure during her extensive chemo. They recommended she get Marinol due to her violent episodes with vomiting and nausea and nothing was working. During one such episode she went to the emergency room and the attending physician gave her a prescription. It took 3 days to get the prescription filled. In the meantime, she was vomiting and extremely nauseated for over 72 hours because it needed prior-authorization. She was unnecessarily violently ill for 3 days just due to a prior authorization; it is ridiculous. The doctors are overwhelmed, and it serves no purpose. The insurance company would kick it back time and time again.

I was getting ready to leave for a trip and had my doctor’s appointment the day before. Afterwards I took my scripts to be filled at the pharmacy and intended to pick them up the next day, giving them plenty of time. They called the next morning and said they needed prior authorization from my doctor and she was not open on Friday, so I had to postpone this important trip because it is a medication I cannot just stop taking. I have been on this medication for years, so for the insurance company to basically ask the doctor to provide more paperwork saying I need it is BS! Of course I need it or she would not have prescribed it. It was so frustrating!!!!!

I saw my gastroenterologist about my gastroesophageal reflux disease (GERD). He gave me samples of Dexilant and wrote a prescription for it. Within three days of switching to Dexilant, the chronic cough was gone. The insurance company, different than the one I had before, required prior authorization for Dexilant. The insurance company would not cover the prescription until I tried three other medications. My doctor gave me prescriptions for the medications, one after the other and they did not work. Then the insurance company informed us that trying each medication means 8 weeks taking it once per day, then 8 weeks taking it twice per day. That works out to 48 weeks of trying medications we already knew would not work, before I could hope to get the medication we already knew did work. By the time the 48 weeks elapsed, the insurance policy ended, and I had to get a policy with a new company, who wants me to jump through the same hoops. More than a year after trying to get Dexilant, I still have my chronic cough and no hope in sight of actually getting the medication I need. Without an effective treatment for GERD, I am at increased risk of several problems, including esophageal cancer.

I am one case out of hundreds that my surgeon has to spend hours upon hours needlessly playing phone tag and writing petitions for his patients so he can provide the care he wants. Outrageous. Exhausting the client and the doctor while keeping our premiums.