Patients and Physicians Speak Out

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 am tired and frustrated by insurance companies and their ongoing denials, prior authorizations, and appeals. This is the height of crap they put patients through. As a sleep doctor, I order sleep studies based on patients’ symptoms and to rule out sleep apnea. Snoring is associated with sleep apnea and is one of its symptoms. Allied Benefit denies sleep studies if we use snoring as one of the diagnosis codes. Go figure that. One insurance [company] denied a sleep study since the term “excessive daytime sleepiness” was not used (layman term). Instead, I used hypersomnia, which is the medical term. They also now deny sleep studies and say patients don't have co-morbidities like heart attack or stroke. Treating sleep apnea is part of preventative medicine. One case, I had to call and was surprised by their rejection. When I called, the doctor representing the insurance company asked, “What is his weight?" and “Does he snore?” All these symptoms are already discussed in his clinic note. They don't read our notes. They think that if they deny, at least some doctors won't call for their patients, allowing insurance companies to save money. This is a nasty way to make billions of dollars. I feel so bad for patients who don't get adequate care on time. I myself go through this as a patient. Tizanidine, which I have ordered for patients. I myself couldn't get it, since my insurance won’t pay, and they said it will cost $400 for a few pills. 

I don't know why I went into medicine. After 12 years of education and +5 yrs of PhD work, I have to haggle with these idiots. We get health insurance to cover our health care, not for them to take the money and deny the coverage. This is what is called elite daytime robbery in the name of healthcare. They think doctors make money. Check the salaries of the CEOs and other administrators of the hospitals and insurance companies. At least pay us for education and the debts we accumulated to get here. I wish I took a different route for my career—business administration in the healthcare industry.

I can't get my medication that could potentially save my life and give me peace of mind because of all the wait times for prior authorization. I am a trauma nurse. I know the field. This. Is. Wrong.

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.