Insurers say prior authorization helps control costs by preventing medically unnecessary care, but patients say the process can delay or deny access to needed treatments.
Sally Nix with her service dog, Jon Snow, at home in Statesville, N.C. Late last year, Nix started receiving infusions prescribed by her doctor to ease her autoimmune disease symptoms. But she had to pause the treatments when her insurer started denying payment for them.Lauren Sausser | KFF Health News
late last year. Commonly called IVIG, the treatment bolsters her compromised immune system with healthy antibodies from other people’s blood plasma.That’s why, when Nix’s health insurer started denying payment for the treatment, she turned to Facebook and Instagram to vent her outrage. “Unfortunately, this has become a routine practice for us to resort to if we don’t get any headway,” said Dr. Shehzad Saeed, a pediatric gastroenterologist at Dayton’s Children’s Hospital in Ohio. In March, he, blaming Anthem for denying the biologic treatment his patient needed to ease her Crohn’s disease symptoms.
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