Patients and Physicians Speak Out

I recently encountered a denial of treatment. I have been fighting ovarian and breast cancer stage 3c since 2013. My [cancer antigen 125] has proven to be accurate and indicative of active disease. I have been on a maintenance regimen, but my marker started creeping [up]. Also picked up a [pulmonary embolism] 3 months ago which is resolved with anticoagulation. This is the fourth or fifth recurrence. I’ve lost track. [Prior authorization] for chemotherapy treatment was sent to [the] insurance company. Denied. The denial letter sent to me reported the determination was made by a board-certified rheumatologist, not an oncologist. My oncologist, upon hearing of the denial, requested an immediate phone appeal with the physician. The insurance company wanted to know why we didn’t wait until we actually saw a tumor. I guess they would rather have my cancer advance more. Not to mention the possibility of an emergency bowel obstruction from a tumor while on meds that would cause bleeding. No common sense. My first thought of the denial was that my insurance company had decided it was time for me to die. My second thought was it was an automatic denial to save money.

I have always thought prior authorization was the biggest waste of time for all involved in the process. If a physician deems the procedure, test, medication, etc. medically necessary, why does it have to be scrutinized by someone who probably doesn't even work in the same area of expertise or [have the] same level of education to make that decision?

The insurance companies really try to justify prior authorization as a safety measure? We all know it is to maximize their profit. They say lack of it will increase premiums? How about lower their outrageous profits? Such evil entities.

I’m a Type 1 diabetic. Although there is no cure for this disease, it can be managed with appropriate prescription medications and an insulin pump. I currently have to obtain prior authorizations for three of my medications…every single year. This year alone I spent at least 40 hours on the phone in connection with my prior authorizations. My insurance company is demanding that I work for it one week per year (i.e., 40 hours) to fight for the medications that my doctor and I know are in my best interest.

Multiple delays and repeated phone calls to insurance, pharmacy and doctors trying to get much needed medication.

I have [apolipoprotein] Cll [amyloidosis] with kidney involvement/failure. I was admitted to the hospital because my blood pressure went up to 247/113. The insurance will not pay because it wasn’t preauthorized. Not sure if they understand that I cannot regulate my blood pressure on command.