Patients and Physicians Speak Out

The need for prior authorizations has caused me damage to my brain that I may never get back. I have multiple sclerosis, a lifelong illness, and my insurance company thinks they know what is best for me. WRONG! In 2015, my doctor wanted me on a medication called Gilenya, a [prior authorization] was sent to the insurance company and came back with a denial. Why? They wanted me to fail THREE medications of their choice before they would cover what my doctor said was best for me. I tried two of the three which led to terrible side effects and an allergy to one of them. Most of all it led to more lesions on my brain. In 2018, the need for a prior authorization for additional rounds of my current treatment led to 2 denials and a relapse during that time, again more damage that I may never recover from. I was told a board-certified neurologist would look at my appeal, I doubt they did. It wasn’t until I went to Facebook and posted on the insurance company’s page that I got momentum in the right direction. I was fed up with the process so on a post with the chief medical officer, I kindly asked if he could review my case. Less than 48 hours later my treatment was approved. It shouldn’t ever come to that. Insurance companies don’t know what’s best for a patient.

I use Dexcom G6 constant glucose monitor for controlling post pancreatectomy diabetes (I have half a pancreas). Getting sensor and transmitter refills for the G6 system is challenged each time by the supplier, Medicare and my secondary insurance. If I use the DME supplier, they request prior authorization, and sometimes refuse to send supplies out of schedule when I need them before traveling overseas. They shave the timing so close that often supplies are delivered late. If I pay cash out-of-pocket to get supplies more timely from the pharmacy it may take about 3 months to get $1,258 reimbursement and 2 to 3 hours of phone calls and emails with the pharmacy, Medicare, and [my health insurance] to get 3-months’ supply of sensors. [Prior authorization] is an unnerving, time-consuming process to be endured for the sake of keeping my diabetes in control and not becoming an even greater burden to the insurance companies as a result of secondary complications that result when the disease is not controlled. This does not make sense.

We used to have good healthcare, years ago, when [prior] authorization didn't interfere with the doctor’s wisdom and compassion. Where is our healthcare now?

I have respiratory issues and got the flu last year. It took insurance 3 weeks to approve Tamiflu for me. I never even got to use it, but I had 2 ER trips for breathing treatments.

I'm a breast cancer survivor. I live in a rural area in southern Illinois.The red tape I go through is insane, especially to obtain my breast MRI each spring that's ordered by my breast surgeon. It scares me because if my cancer does return, I want to be able to begin treatment as soon as possible, without waiting to wade through a bureaucratic mess.

I had a few incidents this year where my son was hospitalized …Took his prescriptions over to the pharmacy after each release. The pharmacy calls me later and tells me the insurance needs to get this authorized . . . The pharmacy was not able to get a hold of the doctor that afternoon. I asked the pharmacist what can we do, he needs the medication and cannot skip it. They look up the cost and it was over $1,400 dollars for a 15 day supply. I didn't have the funds for that. Luckily, there was a refill on a lower dose of that medication on file that had been approved before so all I had to give him was double that dose. When they finally were able to get a hold of the doctor he called the insurance company. If there had not been a refill on file for the lower dose we would have had a big problem on our hands. I would have had to take him back to the hospital.