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HomeOpinion | Denying Your Medical Care is Huge Enterprise in America

Opinion | Denying Your Medical Care is Huge Enterprise in America

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Ought to your insurance coverage firm be allowed to cease you from getting a therapy — even when your physician says it’s needed?

Medical doctors are sometimes required to get insurance coverage permission earlier than offering medical care. This course of is named prior authorization and it may be utilized by profit-seeking insurance coverage firms to create intentional boundaries between sufferers and the well being care they want.

At finest, it’s only a minor bureaucratic headache. At worst, individuals have died.

Prior authorization has been round for many years, however medical doctors say its use has elevated in recent times and now rank it as one of many high points in well being care.

To supply the Opinion Video above, we spoke to greater than 50 medical doctors and sufferers. They shared horror tales a couple of seemingly trivial course of that inflicts huge ache, every day. The video additionally explains how a course of that’s supposed to economize really inflates U.S. well being care prices whereas enriching insurance coverage firms.

Prior authorization has come underneath intense scrutiny in Congress up to now few years, however bipartisan proposals have repeatedly stalled. Below public strain, some insurance coverage firms — like United Healthcare and Cigna — have stated they would cut back the usage of prior authorization. And in January, the Biden administration finalized a plan to place restricted guardrails round this observe. However medical doctors say that these efforts solely scratch the floor and ought to go additional.

This challenge is finally concerning the position of insurance coverage firms in American well being care: Ought to they’ve extra energy than your physician to determine what’s medically finest for you?



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