Patients and Physicians Speak Out
Prior authorization burdens negatively impact patients and health care professionals around the country every day. Explore their stories and share your own experiences to make your voice heard on the need to #FixPriorAuth.
Featured Stories
Yes, just last year I needed knee surgery. The insurance made me go through 2 weeks of resting it then 3 weeks of physical therapy plus a fluid removal attempt. All this before I could even get an MRI that my ortho doc with 40 yrs experience knew I needed in the first place. After the MRI I had to wait 2 more weeks for approval. From start to finish I was laid up 4 months and even lost my job because I ran out of FMLA. Now I have a wrist injury and I am not going for treatment because I really like my new job and I am afraid to go through it all again.
I went almost two weeks without long-acting insulin and two days without even short-acting insulin waiting for prior authorizations. This landed me in the ER 3 times and sent me into a pancreatitis flare. And wasted about 3 hours of my doctor’s time to get insulin. This was not new either; I have been diabetic since I was a kid, so about 25 years. They also made me switch what kind I use, and that caused my sugar to be out of control for weeks, even after I finally got the insulin, while I determined my correct bolus dose of the new insulin.
Share Your Story
Have you ever gone to the pharmacy to fill a prescription only to be told that your insurance company requires approval before they'll cover your treatment?
Have you ever waited days, weeks or months for a test or medical procedure to be scheduled because you needed authorization from an insurer?
Are you a physician frustrated with the administrative headaches and their impact on your patients?
Have prior authorization delays caused you to take more sick days, be less productive at work or miss out on day-to-day life?
Share how prior authorization has impacted you, your loved ones or your patients to draw attention to the need for decision-makers to address this issue. Your voice can make an impact.
All Stories
Use the buttons below to explore how prior authorization impacts both health care professionals and patients throughout the country.
Being a type 1 diabetic, I need insulin pumps and glucose testing supplies. I have been using Omnipod Classics for almost 10 years. The company that I now work for had a health insurance option, HealthNet of Oregon. They immediately rejected my Omnipods because they weren't a necessity. I started paying out of pocket for Omnipod Classics and Dexcom G5 continuous glucose monitoring (CGM) system. I eventually dropped the Dexcom and started testing manually, because I could not afford $3,000 for a 90-day supply.
I ended up spending over $10,000 on credit cards trying to keep my Omnipod supply. In late 2022, I found out my Omnipod Classics were being phased out, so I needed to upgrade. I tried for a whole year to get them approved. My doctor’s office goes through every hoop to send preauthorization paperwork only to have it denied with the reason being ‘not enough info.’
My doctor’s office sent copies of emails with lengthy explanations and records proving the necessity. It wasn't until Healthnet appointed me a case worker that I got a year-long override to have Omnipod 5 and Dexcom G6 CGM system. Now, in 2024, I am still fighting to be reimbursed for the out-of-pocket expenses for medications that should've been approved from the start.
Recently I needed a lifesaving blood transfusion. This required an ER visit. Because I didn't get "prior authorization," I am now stuck paying the cost of the ER. I am 100% disabled, live on less than $1,200 a month, and have had most of the bills go over to collections because I simply cannot pay them in a timely fashion. I would like to know how someone is supposed to get "prior authorization" for a lifesaving ER visit.