Patients and Physicians Speak Out

I am currently dealing with a rescinded approval that my insurance company sent me in writing that gave prior authorization for the one medication that provides better quality of life. They had no issues covering it until January 2025 after over four years of paying for my monthly prescription. I am a Medicaid, Medicare patient. On Thursday, they [insurers] sent me another letter denying and taking back the approval, plus they gave me a window of 72 hours in which to appeal. My doctor's office is not available on Friday, Saturday or Sunday, so I don't know what or how to proceed. This is extremely stressful and causes great duress. How can it be legal to approve and deny in writing within a few days?

I went to a pharmacy to pick up my medication to find out that the insurance company was asking for a "prior authorization," after I took the exact same medication for nearly a decade. Due to the insurer needing a prior authorization, I couldn't fill my prescription, and the pharmacy would be closed for the next two days, so I didn't know what to do. I went home to discuss it with family, and we found no other choice but to purchase the medication with cash for $140.00. It's medication that I need to take daily. Now I'm on disability with very limited income, raising my two great nieces. One [of my nieces] is non-verbal autistic. Do you realize what prior authorization has done to our family and finances this month? It means less money to buy and pay for everything across the table, from food to utilities, gas, and more.

 All because of this unnecessary prior authorization stuff, and it's affecting real world people with real lives and real issues, living check to check while raising children. It's disgusting how the insurance companies play with their insured in hopes they can save money by having the patient walk away or pay out of pocket for services, treatment, and/or prescriptions. This year, 2025 makes it the THIRD YEAR that Humana has forced a prior authorization, and I was made to pay cash for my medication. When I tried to get reimbursement from Humana, they refused to pay me back, then they filed a dispute on my behalf with their company and that too was rejected. Humana ultimately sent me a check for $43, which I never cashed because they owe me $150.00, plus $150.00, plus $140.00 now. Can you not see how prior authorization is critically affecting people of all walks of life and most times it's happening when we're at our worst?

[Prior authorization] shackles my ability to help get the medications my patients need. I have had countless instances where patients have had worsening disease because of the delay and inadequacies of the current PA system.

My insurer makes me fight for every prescription. And, many times, they do it for prescriptions that I have taken for many years. What insurers really want is for us to give up and pay for them out of our own pocket.

The problem for me is getting the prescriptions that I need. I have a back injury that I had surgery for but still have issues with pain, mostly sciatica. My doctor won’t write for narcotics, Tylenol doesn’t help and I can’t take anti-inflammatory meds due to being on blood thinners and having already had a GI bleed. Lidocaine patches are the only thing that eases the pain, but the insurance company won’t cover them without prior authorization and because I don’t have diabetic neuropathy or shingles. Go figure! So now what am I left with for the pain? Absolutely nothing. Why can’t they just use common sense?

I waited 6 days to get approved for Fentanyl patches for my cancer. My oncologist sent the prior authorization too. But these decisions are made on business days. So I had to suffer.