In case you missed it, a new video from The New York Times Opinion sheds light on how some corporate insurance companies misuse prior authorization to delay and deny patient care while inflating their own profits.
The New York Times Opinion explains:
- “New York Times Opinion interviewed more than 50 doctors and patients. Their experiences suggest that insurance companies often weaponize [prior authorization] in order to control doctors and inflate their [own] profits.”
- “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.’”
- “As prior authorization has spread, delays in care have become normalized—so have tragedies.”
- “One in three doctors say that it’s caused a serious medical issue or even the death of one of their patients.”
- “By one estimate, the U.S. spends about $35 billion a year on the administrative costs of prior authorization. These resources could be devoted to patient care.”
Speaking with the Times, physicians shared their first-hand experiences struggling with corporate insurers’ excessive and inappropriate use of prior authorization:
- “This is a really big issue, and it impacts every single person in this country who has insurance.” – Dr. Shikha Jain
- “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.” – Dr. Jessica Korman
- “If they deny care or they delay care, that’s money the insurance company gets to keep.” – Anonymous Pediatrician
- “The way that they profit is to deny care.” – Dr. Jessica Korman
Patients also shared their experiences with corporate insurers’ misuse of prior authorization:
- “It was like the insurance company telling me that my life didn’t matter.” – Ocean McIntyre
- “It’s like I am scared of MS but my fear as of right now is more of the insurance company.” – Michael Trotman
- “I spent so much time on the phone, writing letters, faxing, that I didn’t get to spend that time with my father.” – Vivian Gonzales, who lost her father after his insurer refused to pay for chemotherapy
- “I finally got the authorization to see the neuro-ophthalmologist after 12 weeks, and he said, ‘We’re going to do this surgery, but it’s only to preserve the vision you have left. If we had seen you earlier, that would have been a different story.’” – Ocean McIntyre
As the evidence continues to grow that some corporate insurers routinely delay and deny care through excessive and inappropriate use of prior authorization, a recent survey revealed that enrollees in Medicare Advantage (MA) are more likely than traditional Medicare enrollees to report delays in receiving care due to prior authorization practices.
At the same time, a recent report by the Medicare Payment Advisory Commission (MedPAC) uncovered that Medicare Advantage is projected to cost taxpayers $88 billion more in 2024 than the government would have spent through traditional Medicare.
Policymakers must take action to protect patients from corporate insurance companies who prioritize profits by delaying and denying necessary patient care. It’s time for corporate insurers to stop impeding patients’ access to care and instead let hospitals and physicians do what they do best: provide vital, 24/7 care to patients when and where they need it.