Name: Denying Your Health Care Is Big Business in America | NYT Opinion
Uploaded: 2024-01-20T02:15:07.000Z
Duration: 8 min 38 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

Your doctor refers you to a specialist but your insurance blocks the referral.

Call me to defend why you think this patient needs this.

Imagine you have multiple sclerosis without warning.

No, you cannot order this image prescribes chemotherapy.

Have you considered this other less expensive option?

An absurd process has infiltrated American health care.

Here's how it works before your doctor provides a treatment.

Your insurance requires them to prove it's necessary.

This is often a time consuming process that can cause dangerous delays.

I'm sorry your cancer could be cured, but we need to wait for the insurance company to approve your chemotherapy.

That's doctor Jane, she's barricaded by prior authorizations daily.

This is a really big issue and it impacts every single person in this country who has insurance.

Prior authorization was actually created to save you money decades ago.

It was used sparingly only to make sure expensive treatments like long hospital stays were absolutely necessary.

But now it's devolved into now a system where a lot of times things are really denied for no reason.

Even everyday medications now require insurance approval could be for medications to treat heartburn.

A DH D medication test strips for patients to be able to check their blood sugar chemotherapy PROzac.

When I prescribe a medication, I would say 95% of the time I have to obtain a prior authorization.

New York Times opinion interviewed more than 50 doctors and patients.

Their experiences suggest that insurance companies often weaponize this mundane process in order to control doctors and inflate their profits if they deny care or they delay care.

The insurance company gets to keep the way that they profit is to deny care as prior authorization has spread, delays in care have become normalized.

One in three doctors say that it's caused a serious medical issue or even the death of one of their patients.

It was like the insurance company telling me that my life didn't matter, Michael couldn't walk or stand for four months.

It's like I am scared of MS but my fear as of right now is more of the insurance company and Vivian lost her father.

I spent so much time on the phone writing letters faxing that I didn't get to spend that time with my father, this is medical injustice disguised as paperwork.

When your prior authorization is denied, you have three options.

But healthcare is so ridiculously expensive.

That's what happens up to 80% of the time a win for your insurance company or your doctor can go to bat for you.

When our prior authorizations get denied, we have to do what's called a peer to peer.

A peer to peer is supposed to be a phone call where you call somebody who is your peer to justify the treatment that you want to deliver.

I'm a pediatrician and sometimes I'll end up talking to a neurologist, people who couldn't pronounce the names of the drugs.

Now, imagine you have to do that 5 to 10 times a day.

What's even more ridiculous about this whole process is that after we go through all of this, if you're really a determined provider, you'll probably get your drug or your procedure authorized.

Insurance companies say that this process helps reduce the cost of expensive treatments, ensure safety and lower the total cost of care.

But what it's actually doing is creating a lot of expensive bureaucracy.

We have four full time employees who their sole focus is on obtaining prior authorization for medications to treat Crohn's disease and ulcerative colitis.

By one estimate, the US spends about $35 billion a year on the administrative costs of prior authorization, these resources could be devoted to patient care, answering phones in a timely fashion.

I might actually get to go home and see my family on a regular basis.

Some companies have actually pledged to reduce prior authorizations but those efforts only scratch the surface.

I am a board certified gastroenterologist.

I know what I'm doing only to be blockaded by all of this bureaucracy red tape which really only serves to enrich the insurance companies.

Last year elev made 6 billion United Healthcare made $22 billion.

I had a patient who had a new diagnosis of lymphoma and the insurance company was giving us a hard time to give the chemotherapy.

I got someone on the phone and I told the person I said I need your name because when this young man dies, I want to tell his parents who was the reason behind it.

I went home and I cried after I hung up the phone because I was so emotionally exhausted and that was just one patient.

I had seen 25 other patients that day and many of them would eventually need prior authorizations as well.

Prior authorization gives your insurance company more power than your doctor.

Now, there are some complicated cases when it makes sense to double check that your doctor isn't unnecessarily overprescribing.

Imagine you've had a cancerous tumor removed to be extra safe.

Your doctor recommends an additional treatment, but it costs 100 and $70,000.

On the one hand, I can see where insurance companies are coming from with, you know, wanting to take a careful look at these expensive treatments.

Then on the other hand, I'm a human and I'm a young mom.

The question is, do you think they made that decision based on what was in her best interest or theirs in many countries?

These tough ethical decisions about what is covered are made by governments not for profit insurance companies.

The government should abolish prior authorization or at the very least reform it.

My goal with Senate Bill 247 is to reform the prior authorization process.

Bill 3459 creates a streamlined prior authorization process known as quote gold carding.

A handful of states have created gold card programs.

Doctors who have successfully obtained prior authorizations in the past are exempt from needing to obtain them again.

All states and the federal government should pass laws like these.

Your insurance should not be a barrier between you and the health care you need.

I finally got the authorization to see the neuro ophthalmologist after 12 weeks and he said we're gonna do the surgery, but it's only to preserve the vision you have left if we had seen you earlier.