Pittsburgh Man On Insurance Delay: ‘What If I Would Have Died With This?’

Studies show that people suffering from severe, untreated sleep apnea die at rates more than three times of those without apnea.

      Watch video from Jeff Duncan and other patients who have been impacted by prior auth

Pittsburgh resident Jeff Duncan was convinced he had a sleep disorder when his mother noticed he momentarily stopped breathing while taking a nap in late 2016.

"I knew I had to do something about it," he said.

But delays from insurance prior authorizations kept him from receiving treatment for almost eight months.

"This is a man I was very worried about," said neurologist and sleep medicine specialist Maria Sunseri, MD.

In order to diagnose the severity of Duncan's disorder and get him a machine that could treat it, Dr. Sunseri sought prior authorization from Duncan's insurance company to do an in-lab sleep study. Duncan's insurance denied the in-lab study, instead suggesting a second in-home study.

After conducting a second in-home study, Dr. Sunseri still had to spent months going through more paperwork and phone calls with Duncan's insurance to secure him an in-lab study. It was finally approved and the results indicated what Dr. Sunseri suspected for nearly eight months – that Duncan needed a continuous positive airway pressure (CPAP) machine to treat his severe sleep disorder breathing.

   Help Us Reform Prior Auth 

Legislation has been introduced (House Bill 1293) that aims to decrease patient wait times by streamlining the prior authorization process and increasing transparency from insurance companies.

Take Action 

Duncan is now getting the treatment he needs, but said the delay could have been costly.

"What if I would have died with this?" he said. "Personally, I'm just irritated that the insurance companies have so much power over doctors trying to get their patients what they need."

The Pennsylvania Medical Society and a coalition of 50+ patient and physician organizations support legislation (House Bill 1293) to improve patient wait times on prior authorization. Visit www.pamedsoc.org/PriorAuth to see how you can support HB 1293.

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