Patients and Physicians Speak Out

I am deaf and prior authorization is an additional barrier to me receiving prescriptions for my health and mental wellness. Calling back doctors’ offices and playing phone tag is downright difficult for me, and my average time depending on the office is several days to two weeks in correcting the matter. I also switched insurance, and many of my medications I was already taking and doing well on required prior authorization when I went to refill. I had issues with missing doses. This feels like insurance companies practicing medicine without a license.

Prior authorizations routinely delay patients being able to see me and to get radiologic and other studies done in a timely fashion. I am a gyn oncologist, and I have seen patients with cancer wait for months to get an appropriate referral to a gyn oncologist. One recent cancer patient of mine waited 6 months to see 3 physician specialists for surgery. Once she had seen them and set up her surgery, her scan was repeated (she had to wait a month to get this approved also) and she had disease progression and was no longer eligible for surgical cure. This patient was 27 years old. I had to call her and tell her we needed to cancel her surgery. She may never be eligible for curative surgery again. This delay most likely significantly worsened her prognosis and will contribute to a family losing their daughter, wife and mother. This needs to end now.

[Prior authorization is] frustrating, time consuming, NO value added, and delays care and even puts [patients] at risk for life-threatening situations. Utter, utter waste of time and energy.

Just [yesterday], I had a patient that needed a STAT computed tomography angiography (CTA) in whom I suspected pulmonary embolism (PE). But nope! Needed a [prior authorization] — went to review (!) and told us to call after noon. Fortunately, they approved it. Lo and behold- the guy has [bilateral] PEs and ended up in the hospital. There are thousands of such stories all over the country and still not a thing being done about it! Why aren’t insurance companies held responsible? Why aren’t they held accountable AND liable for any bad outcome??

I worked for a surgeon and spent untold hours pre-certifying surgeries, getting approval and a precert number. Then after filing for payment, it would be turned down, another phone call and finally payment sent. This happened all the time. Many insurance companies stall and stall before paying. No wonder doctor bills are high. They have to hire extra people to put up with all this [prior authorization] bulls**t.

I am a doctor but experienced how badly prior authorization affects patients with my daughter’s experience. She was prescribed a very expensive medicine, which is covered by insurance. The medication is required to be filled (picked up) within a week. Our insurance prior authorization process takes longer than a week. Hence, insurance didn’t cover the medication cost. All the insurance company had to do to save money was to slow-walk the process. I paid cash for the medicine with a GoodRX coupon. I live in an impoverished area, and I know that none of my patients’ families could afford to do that.