Prior Authorization

See how prior authorization delays in Pennsylvania hurt patients and physicians. Share your story and help us #FixPriorAuth.

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Why does the insurance company get to dictate our lives?
Windsor, PA
James A. Read More Why does the insurance company get to dictate our lives? They don’t know the patient or what the patient has been through. But they get to dictate what we can take. It’s not right.
I am a care giver recently fighting with the insurance company for pre-authorization.
Easton, PA
Dawn C. Read More I am a care giver and recently have been fighting with the insurance company for a pre-authorization for medication for my husband. My husband has been without the proper medication for almost two weeks now. This process is doing damage to my husband but no one seems to care.
What if I would have died with this?
Pittsburgh, PA
Jeff D. Read More What if I would have died with this? Personally, I'm just irritated that the insurance companies have so much power over doctors trying to get their patients what they need.
My medication has always been approved, but the wait has taken a toll on my health.
Wilmington, DE
Jennifer D. Read More I have moderate to severe Psoriatic Arthritis. I’ve tried several biologics and, on average, it takes two months for prior authorization. While waiting for authorization I have pretty severe setbacks, pain, stiffness, swelling. The damage to my skin, from swelling, resulted in a horrible wound on my lower right leg and required three months of wound care. My medication has always been approved, but the wait has taken a toll on my health.
They are putting my life in danger by delaying treatment.
Easton, PA
Susan E. Read More I have been diagnosed with moderate pulmonary hypertension. I have been waiting two weeks now for my medication to be approved on the first attempt it has been denied. I am short of breath and cannot walk up more than one flight of stairs without increasing my shortness of breath. They are putting my life in danger by delaying treatment.
Prior auth lead to partial treatment.
Phoenixville, PA
Grant E. Read More

Doctor sent in prior auth for radiation treatment.  Treatment denied.  Resubmitted and now approved for half treatment.

This was a very unnecessary delay!
Lititz, PA
Lois G. Read More It is apparent to me that my functioning would be less compromised if the surgery would have been done in March and I would have endured less pain and use of medications. This was a very unnecessary delay!
Patients are often not aware of auth requirements.
Titusville, PA
Barbara H. Read More Patient is trying to obtain authorization for a partial knee replacement surgery. Turns out she needs to do their wellness program which consists of smoking cessation counseling, weight loss and management, and stress management. They are asking what her exercise regimen is, but she cannot do exercises with her knee issues. This patient works in the medical field and is fully aware of requirements with insurances but everyone she speaks to never heard of these requirements for the type of surgery, including the physician.
Prior auth can lead to time-sensitive complications.
Willow Grove, PA
Dr. Patricia H. Read More I am a pediatrician. I saw two kids today, both of whom have asthma, and I diagnosed them with influenza. Insurance company did not approve Tamiflu and says they need a prior auth. They need to start Tamiflu in first 48 hours so this will delay their treatment and potentially lead to complications.
I was diagnosed with a brain tumor and was refused coverage.
Stevens, PA
Kirsten J. Read More I was diagnosed with a brain tumor. Due to its size and location my doctor wanted me to have a MRI spectroscopy. My (insurance) company at the time refused to cover it and has continued to refuse coverage. It is absolutely awful that insurance companies can dictate what is and is not necessary for patients. This needs to change!
Surgery was delayed as a result of their denial of my doctor's request for an MRI.
Mount Gretna, PA
Mary K. Read More Surgery was delayed as a result of their denial of my doctor's request for an MRI. I experienced excruciating pain for many weeks while waiting for a diagnosis. … It is three years since this happened and I am not able to perform all household chores, can no longer lift or carry medium weight objects, and cannot stand for even short periods of time.
I go through days of pain at the mercy of their delays.
Chester Springs, PA
Jennifer M. Read More Each year I am forced to go without my medicine for days while the insurance company takes days to approve. I go through days of pain at the mercy of their delays.
Insurance does not have control over third-party systems.
Scranton, PA
Pam M. Read More The insurance company does not seem to have control over the abyss of third-party systems. My medical situation should have followed me in order for the claims to have been reviewed in full context of my medical history. It should not have been isolated.
I thought I was going to die.
Glen Rock, PA
Clarence N. Read More Because I was so short of breath, my doctor was very concerned and recommended that my procedure be done as soon as possible. Unfortunately, it was cancelled because my insurance said that it needed ‘pre-approval.’ My wife and I were terrified because my shortness of breath had become so bad that I thought I was going to die.
Fast forward three years, I was diagnosed with AFib.
Plains, PA
Kathy O. Read More My physician felt I had sleep apnea. The insurance company refused to approve first part of test. Fast forward three years, I was diagnosed with AFib and needed an ablation. Post heart procedure, the sleep study was approved. I have severe obstructed sleep disorder, stop breathing several times an hour. I now use a CPAP nightly. I still have heart issues.... I feel the sleep study would have uncovered the apnea and prevented the AFib.
Maybe I would have never ended up in a wheelchair.
Pittsburgh, PA
Kristen O. Read More I didn't know the severity of what I had. The only way they had of knowing would be to do the MRI. If I had gotten the MRI earlier and started on the MS infusions, I really believe it could have kept some of these symptoms at bay. Maybe I would have never ended up in a wheelchair.
Prior auth required for long-term medication.
Philadelphia, PA
Ian P. Read More Getting a pre-authorization for a medication I’ve been taking for over 15 years.
Sometimes there are incidental findings that need to be remedied.
Sellersville, PA
Donna R. Read More This is frustrating as we take every precaution when obtaining prior authorization for surgeries but sometimes there are incidental findings that need to be remedied.
How long does a patient with cancer have to wait for treatment?
Johnstown, PA
Aliaa S. Read More It took two weeks to issue a denial from a third party, Evicore, stating, “other preferred drugs could be administered.” How does a third party, not even the insurer, get to make that call? How long does a patient with cancer have to wait for treatment?
Are you trying to cut costs, or are you trying to cut lives?
Montgomery County, PA
Joe S. Read More

You could talk to two different people at the insurance company in the same day and get two different answers. Are you trying to cut costs, or are you trying to cut lives?

Prior auth still required to wean off opioids.
Montgomery County, PA
Dr. Daniel S. Read More One could imagine a reason for (denying it) if we’re increasing the medication, but in Joe’s case, we were gradually decreasing the medication. In spite of the fact that we were doing the right thing (by lowering his dosage) – getting him off opioids – pre-certs would still be coming.
I called our insurance companies every day for nearly a month.
Middletown, PA
Laura S. Read More My son’s rheumatologist prescribed him a specific treatment. I called our insurance companies every day for nearly a month before they secured the prior authorizations needed to pay for the drug.
If I would have waited for the denial, I would have died.
Blandon, PA
Pam W. Read More Needed a stent immediately. Eight days after my surgery, I got a denial of service (from insurance company). It didn't really impact my life. It was not all paid at first but my Medicare Senior Blue picked up the balance. If I would have waited for the denial, I would have died as my artery was 90 percent blocked.
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86% … medical groups that experienced an increase in the number of prior authorizations (source: MGMA 2017 survey)
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29.1 … average prior authorizations per week per physician (source: AMA)
jeff
92% … physicians who say prior authorization results in care delays (source: AMA)
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