Opinion | I’m a physician. My selections are overruled by medical health insurance denials
Elisabeth Rosenthal’s Might 18 Thursday Opinion essay, “Denials of health-insurance claims are rising — and getting weirder,” hit the nail on the top. As a rheumatologist, I see many sufferers who wrestle to maintain up with their day by day actions and depend upon entry to mandatory therapies to handle their power ache. Insurers’ prior-authorization insurance policies amplify my sufferers’ wrestle by constructing ineffective hurdles and delaying entry to drugs I do know are greatest for my sufferers. Greater than 54 million Individuals live with a rheumatic diseaseand delays of their care can imply irreversible illness development and everlasting lack of bodily features.
Prior authorization, the method by which well being insurers require medical doctors to request protection approval for medically mandatory care, has gotten out of hand. I’ve seen the quantity of requests develop exponentially, forcing many practices, together with mine, to dedicate monumental sources to rent employees particularly devoted to coping with this monumental administrative burden. Usually, these requests are delayed and denied by representatives who don’t work in the identical specialty, which means my years of medical training, coaching and relationship-building with sufferers are sometimes arbitrarily overruled.
I’m grateful the present administration has taken step one to suggest guidelines that will restrict using prior authorization, making the method extra clear and environment friendly. However extra have to be executed. I urge policymakers and Congress to implement options to cease insurers from overtaking the medical decision-making course of and defend long-term affected person well being.
The author is a member of the American School of Rheumatology.
#Opinion #physician #selections #overruled #well being #insurance coverage #denials, 1685310003