Patients and Physicians Speak Out

I work in oncology, account receivables and prior authorization. It is heinous work. Treatment is OFTEN delayed while waiting for prior authorization. Honestly... why the eff do you need prior authorization for CHEMOTHERAPY? It's not elective!

I work doing authorizations for a hospital and physicians' network that has 2 acute care facilities and at least 100+ physicians. I’ve had patients whose care has been delayed for 3+ months because of incompetence on the part of the insurance company. They don’t read the documentation sent, or they aren’t even properly aware of their own medical guidelines.

I work in healthcare and prior authorization is the biggest waste of time and money. As it’s been said, they have a person sitting in a cubicle somewhere who doesn’t know you, who has never met you, determining if you need the testing, procedure or medication your doctor has ordered. A doctor’s office has to provide chart notes and CPT and ICD10 codes. This can take days and sometimes weeks and sometimes an appeal before an authorization is given. Ironically, after all this time wasted and patients waiting sometimes in pain or worry about a lump/tumor/cyst....the insurance company states that prior authorization doesn't guarantee payment and benefits are determined when the claim is received. So by their own words prior authorization is meaningless yet without it they won’t pay. Prior authorization is supposed to prevent unnecessary treatment which by the way still happens in spite of this rule. . . . There is entirely too much power given to insurance companies and pharmaceutical companies as well. These huge corporations are bonus driven....whenever a company is for-profit and bonus driven, the best interest isn't for those they work for; they only watch out for themselves. It’s not about patients...we are just a # to them....it’s the bonus that matters. We need insurance to pay for the services we need...quit raising premiums and giving us less coverage!! Deductibles and out of pocket and even copays have gone up.

I have spent hours and hours getting prior authorizations. Many patients just give up. Sometimes patients have to suffer and show they tried a lesser med and failed before the med originally recommended is covered. So meanwhile the patient suffers the symptoms while they are forced to do their trial of cheaper med. Terrible care and really disgusting that a physician has no say over his patients.

I work in health care, the prior authorization process is very cumbersome. Despite laws prohibiting cancellation or rescinding an auth, carriers do not adhere to these rules. Claims are denied many times in error. Trying to get a prior auth for an unlisted code is even worse. 

I have a patient with a crush injury to his foot who waited 2 months for appropriate imaging studies and then SIX months for approval to operate. Tell me our system is the best. Please. I have many examples. Everyday.