Patients and Physicians Speak Out

In my psychiatric practice, I help patients do well on a variety of medications that must be maintained indefinitely. Even though the need for maintenance is well established in the literature, insurance carriers require that [prior authorizations] be renewed yearly or more often, consuming a lot of my and my staff’s time. Obtaining [prior authorizations] takes at a minimum a few days, and sometimes, in the case of rejections, weeks. During that time, patients are not treated. Some have gotten much worse and ended up in the hospital. The delays put patients' lives at risk.

I work in healthcare. Providers are jumping through too many hoops, at great financial cost, to be able to provide clinically appropriate and medically necessary treatment for their patients. We get a prior authorization, only to have our claims be denied for "no auth." Healthcare decisions should be left to the clinician, not the insurance carrier. The prior authorization process is broken and needs to be overhauled.

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. 

Prior authorization has become a nightmare. I cannot tell you how many times I receive incorrect information (i.e. call three different people and get three different answers. This doesn't make me feel confident). As well as the fact when you do call as the patient is waiting for treatment the doctor and his technicians are waiting to do their job, you are on hold. You jump through hoops to finally get through to a live human being, only to give the same info you have given three or four times already. It backs up our entire day and flow. Not to mention the back of the insurance cards do not always give the pharmacy benefit manager so you are re-routed to maybe one (if lucky) or two different departments. As a healthcare worker for more than thirty-five years, I have only seen this process get more and more difficult to navigate. I feel it does not serve the patients nor the doctors and staff. We try to treat and care for our patients with the best intent with our hands tied.