Patients and Physicians Speak Out

Prior authorization for proper medical equipment and subsequent denials is what led to my mother's early demise and significantly lowered her quality of life. Now, I am also receiving similar prior authorization issues that are making it difficult for me to get medication. If you're on the same drug and the doctor increases the dose, why is there a prior authorization needed when they already have a prior authorization for the drug? This is absurd and is just an attempt to make it so difficult for the doctor, the pharmacy with excessive paperwork and the patient to get proper care.

[Prior authorization is] frustrating, time consuming, NO value added, and delays care and even puts [patients] at risk for life-threatening situations. Utter, utter waste of time and energy.

Just [yesterday], I had a patient that needed a STAT computed tomography angiography (CTA) in whom I suspected pulmonary embolism (PE). But nope! Needed a [prior authorization] — went to review (!) and told us to call after noon. Fortunately, they approved it. Lo and behold- the guy has [bilateral] PEs and ended up in the hospital. There are thousands of such stories all over the country and still not a thing being done about it! Why aren’t insurance companies held responsible? Why aren’t they held accountable AND liable for any bad outcome??

I did prior authorizations for years in a physician’s private office as the practice’s RN. GOOD LUCK to all of you unfortunate enough to have to do this job! 

I had a few incidents this year where my son was hospitalized …Took his prescriptions over to the pharmacy after each release. The pharmacy calls me later and tells me the insurance needs to get this authorized . . . The pharmacy was not able to get a hold of the doctor that afternoon. I asked the pharmacist what can we do, he needs the medication and cannot skip it. They look up the cost and it was over $1,400 dollars for a 15 day supply. I didn't have the funds for that. Luckily, there was a refill on a lower dose of that medication on file that had been approved before so all I had to give him was double that dose. When they finally were able to get a hold of the doctor he called the insurance company. If there had not been a refill on file for the lower dose we would have had a big problem on our hands. I would have had to take him back to the hospital.