Spreading the Word on the Prior Authorization Sham

Whenever we can, we take what we learn from our individual cases and work to change policies or practices to prevent these problems from happening to others.  In her letter, Meg wrote about a family stuck with a bill after being told a procedure was covered and did not need “prior-authorization.”  It wasn’t the first time we had seen a post-care reversal of coverage, so we asked a well-known health care guru to join a student and Meg to write an article exposing this practice.

We submitted the article and the editors requested more data on the frequency of these reversals and their financial impact, so we began searching. Perhaps not surprisingly, insurers don’t give out this information, so we have embarked on a journey underground. We are tapping into many sources, including whistle blowers inside insurance companies and billing representatives willing to speak only on condition of anonymity.  Meg describes the experience: “I feel like Bob Woodward and Carl Bernstein, waiting for “Deep Throat” in random parking garages late at night.”

With or without the data, this story will be told!  We will keep raising patients’ voices – especially those that are seldom heard – to make sure they get access to the care they need and don’t have to go bankrupt in the process!

Read the full article at: https://jamanetwork.com/journals/jama/article-abstract/2760655