Patients and Physicians Speak Out

We have patients who have paid insurance for years, need spine surgery for pain, and because they don't meet criteria they are denied.

I had a patient in her late forties who had been a smoker since her early teens. She came in with hemoptysis and shortness of breath. A chest x-ray revealed a single 2 cm nodule in her left upper lung field. I wanted to get a CT of the chest to better characterize this as it was most likely lung cancer. The response from the insurance company was she could not have a CT scan until she had first undergone six weeks of physical therapy. Yes, you read that right. Physical therapy. I told the idiot on the other end of the phone that if 6 weeks of physical therapy could cure lung cancer, we would have a miracle on our hands. It still took three more phone calls and faxing over office notes before I could get the CT scan approved. It took almost 2 weeks.

I have a family history of death from breast cancer, from my birth mother. For 20 years I barely dodged breast cancer, and now I was growing 2 masses a year. Doctor wanted to do the BRCA genetic testing to find out if I carry the genetic factor for breast cancer— denied. My insurance would cover total mastectomies with reconstruction, but they would only allow and pay for 23 hours from start of the surgery, spending the night to discharge. Since my husband and I are retired and will be RVing, we chose bilateral mastectomies, prophylactically, no implants. Done with some clipboard cutesy deciding my life and future.

My daughter had a fractured ankle....[the health plan] refused emergency room service. We had to wait until the next day to get authorization to take her to the ER for x-rays. By then, it was so badly swollen, they could only soft cast it to stabilize it. She was in a cast for another 3 months.

1 lousy MRI and a visit to a neurologist would’ve saved me 10 years of agony and a $300,000 surgery. Insurance company shareholders are dumb as a box of rocks to put up with that.

I went almost two weeks without long-acting insulin and two days without even short-acting insulin waiting for prior authorizations. This landed me in the ER 3 times and sent me into a pancreatitis flare. And wasted about 3 hours of my doctor’s time to get insulin. This was not new either; I have been diabetic since I was a kid, so about 25 years. They also made me switch what kind I use, and that caused my sugar to be out of control for weeks, even after I finally got the insulin, while I determined my correct bolus dose of the new insulin.