Guest Author
I always thought that paying health insurance premiums month after month, year after year, meant that my insurance would help me pay for necessary care when I needed it. Recently, I learned that’s not the case.
I retired from the City of Melbourne police department after 30 years because I wanted to get some rest and spend more time with my grandchildren. But recently, my brother was diagnosed with the “widow-maker,” a large blockage in one of his main arteries. Paired with my family’s history of heart disease (my dad died of a heart attack at only 57, never getting the opportunity to meet his grandkids), this scared me, plain and simple. I couldn’t sleep at night because of health concerns.
So, I decided I would try to break my family’s cycle and catch heart disease before it caught me. I saw my doctor. He ordered multiple tests to ensure that if I did have any health issues, we would be able to catch them early and act quickly.
But, it turned out I couldn’t go through with those important tests. Why? My health insurance company denied my doctor’s requests for “prior authorization.” My doctor had ordered several tests to check on my heart health, including a cardiac stress test and blood work, but my insurance carrier denied the requests. Months later, I was shocked to find the same process played out with my ophthalmologist – my doctor ordered blood work because of vision problems that sent me to the ER, and my insurer refused to pay for it.
I started to read about corporate health insurance companies and the practice they use called prior authorization. I realized that my story wasn’t the exception – it was the norm.
Prior authorization is a commonly used practice that requires our physicians to ask for-profit corporate insurance companies for permission before they can treat us – even for basic things such as carrying out a medical test or filling a prescription.
And all too often, corporate insurers fail to grant that authorization, sometimes for no reason at all. They use prior authorization to arbitrarily deny requests for tests, blood work, surgeries and doctors’ appointments, all so they can put more money into their pockets.
These are tests that doctors – trained professionals – have ordered.
Denying these requests has a direct impact on patients like me.
In a recent survey of doctors in the United States, 94% said that prior authorization requirements delayed the care that patients needed. Ninety-three percent said prior authorization negatively impacted patients. I’ve seen this happen in my own case.
I’ve gone months without the tests my doctor recommended because my insurance refuses to cover them. If my trained doctor believes a test is necessary, why should an insurance company be able to override them? If I do have a heart problem like my brother or my late father, my care for that problem is significantly delayed.
Corporate insurers’ tactics also harm doctors. The administrative burden of fielding all these bureaucratic requests, filling out paperwork, and filing appeals when insurance companies deny needed care – it all causes doctors to spend less time with patients and forces them to shift money toward hiring additional staff whose sole responsibility is dealing with insurance companies.
Physicians report that they and their staff spend about 12 hours every week completing prior authorizations for corporate insurance companies. And the vast majority of doctors say that prior authorization increases burnout in their field.
Doctors should spend their time with patients, not doing busy work for health insurance companies that prioritize their own profits over patients.
And corporate health insurance companies should be doing their job: Actually paying for the care that patients need.
To a corporate insurance company, denying a heart stress test might mean some extra dollars in their quarterly profits. But to me, denying that test means not having the peace of mind that I’ll live long enough to watch my grandchildren grow up. Having my care denied not just once but four times (and counting) makes me feel like a cog in a machine. It makes me feel like my health insurer values money more than my life.
Something must be done.
Our policymakers need to hold corporate insurance companies accountable for their harmful practices that hurt both patients and doctors. We need to reform the prior authorization process so that stories like mine become less common. We need to make sure hospitals and doctors have the resources and support they need to provide lifesaving patient care.
If there’s one thing this experience has taught me, it’s that there is a lot that needs to be done to improve our health care system. Reforming prior authorization and ensuring that corporate insurers don’t put profits over patients is a good place to start.
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Cyril Hopping is a retired police officer who lives in Brevard County.
