Patients and Physicians Speak Out

I am a maternal-fetal medicine specialist in Nevada. More than 99% of the time, we have to obtain prior authorization for a procedure (usually an ultrasound on a pregnant patient). However, it takes more than a week to get the authorization back from the insurance company. Then, we have to contact the patient and get her scheduled. Now, she has had to wait weeks for an ultrasound only to find out there was a lethal birth defect. WHY should we have to obtain a prior authorization when it is always approved after a delay? How can this be good care? 

It definitely costs our practice a great deal of money to hire people to obtain prior authorization, not to mention the poor patient who has to wait for the insurance company to approve something that we knew would be approved. It is just bad medicine, and the patient suffers the most.

My children have [a health plan] which required prior authorizations excessively and has resulted in my children going without needed medication which they had a history of taking previously. My 15-yr-old then spent 48 days inpatient between 4 hospitals due to a serious neurological condition. On two occasions, he was denied medication prescribed by his specialists. I could not afford to pay out of pocket so he went without needed medication. I don’t think my son’s medical specialists should be second guessed and overridden by an insurance company.

Side effects of the most common diabetes treatment drug made it impossible for me to take. The doctor gave me samples of the drug he felt worked best. My insurer required me to try another drug at a huge co-pay to me before they would consider filling my prescription. They then required the doctor to justify not keeping me on the drug they wanted me to use and then filled it for only three months.