Patients and Physicians Speak Out

As a prescriber for children, I found the [prior authorization] system immoral. It caused delays in treatment for my kids with ADHD, severe anxiety and mood disorders, and PTSD. I always wrote in the comments space: “Congratulations! Once again you have - for no clinical reason - successfully interrupted and delayed essential treatment for my patient.”

I’m a Type 1 diabetic who EVERY year has to wait for prior authorization for the same insulin pump and continuous glucose monitor (CGM) supplies I’ve been using for YEARS with the SAME insurance company and plan. This results in me going without, begging friends, asking the doctor for extras, etc. I’m switching to a new CGM and can’t get it preauthorized without the previous [prior] authorization being removed, which I’m told can take days. More delays, less good blood sugar control. I spend so much time on the phone — including HOURS on hold— because of [prior authorization] insurance baloney and get VERY stressed out, which drives up blood sugars. I’m used to advocating relentlessly for myself unfortunately, but I fear for the people who don’t know how to, or don’t have time, or believe what they are told even when it’s the insurance company that made the mistake.

I have multiple medical issues. I pay for my health insurance 100% out of pocket as I own my own business. I have had three major issues with prior authorization in the past eight months. Two were insulin. Each time my insurance denied me medication because it was over the amount of insulin they allow, which is crazy because dosage is determined by blood tests. The first time it was nearly two weeks without insulin. I was very ill from this and had to beg and borrow insulin from other diabetics to get through. The second time, it was eight days. Again, I was quite ill. The insurance company literally did not care how they were endangering my life. At the end of my insurance policy, I switched to a new company with a much higher monthly premium hoping to avoid these issues. By March, the new company refused to fill my thyroid medication at the prescribed dose. They forced the doctor to lower the dose. As a thyroid cancer survivor, I do not make any thyroid hormone on my own. All of it comes from medication. My TSH level should be at 1 for health and safety and to prevent cancer reoccurrence. However, the new dosage was not enough and my TSH was nearly 50x higher than it should be. I filed with the state insurance board with no response so far. Therefore, I am currently purchasing the correct dosage online. What insurance companies are doing is, frankly, inhumane and evil. Their greed is ruining lives.