Patients and Physicians Speak Out

As a former Hospital Case Manager, it was very common for patients to be forced to remain in the hospital three extra days, while we waited on the insurance companies to review the chart and give authorization for discharge plans.

And then you may have to argue with an insurance worker who is looking at a chart and knows NOTHING about medical care. I know, I was a medical office manager. I had to go to supervisors and argue my case why a patient needed a procedure.

I have yet to have a single insurance successfully deny a procedure or diagnostic for a patient (though I have had to appeal them, and some of them are needlessly convoluted). They're a f***ing waste of time and resources for both providers and coverage entities.

As a nurse I would spend 30 minutes or more on prior authorizations. The insurance companies would expect doctors to do these calls!  I would often call the insurance company to speak to a prior auth agent who obviously was not medically trained. They could not even correctly pronounce the medication name! They had no idea what the drug was for. They were just working off an algorithm. Try telling them a complicated reason why this patient must have this med...not gonna happen. In my opinion, this is all a way to prevent patients from getting drugs they need. Basically, some uneducated prior auth agent gets to nix a physician order!!!

Post-op patients are going home without pain meds due to prior authorization. Patients requiring imaging studies in order to determine a treatment plan are not receiving appropriate care due to delays caused by prior authorization.

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!!!