Denying Your Health Care Is Big Business in America | NYT Opinion

Should your insurance company be allowed to stop you from getting a treatment — even if your doctor says it’s necessary?

Doctors are often required to get insurance permission before providing medical care. This process is called prior authorization and it can be used by profit-seeking insurance companies to create intentional barriers between patients and the health care they need.

At best, it’s just a minor bureaucratic headache. At worst, people have died.

Prior authorization has been around for decades, but doctors say its use has increased in recent years and now rank it as one of the top issues in health care.

To produce the Opinion Video above, we spoke to more than 50 doctors and patients. They shared horror stories about a seemingly trivial process that inflicts enormous pain, on a daily basis. The video also explains how a process that is supposed to save money actually inflates U.S. health care costs while enriching insurance companies.

Prior authorization has come under intense scrutiny in Congress in the past few years, but bipartisan proposals have repeatedly stalled. Under public pressure, some insurance companies — like United Healthcare and Cigna — have said they would reduce the use of prior authorization. And in January, the Biden administration finalized a plan to put limited guardrails around this practice. But doctors say that these efforts only scratch the surface and should go further.

This issue is ultimately about the role of insurance companies in American health care: Should they have more power than your doctor to decide what’s medically best for you?

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[astocktonfilms]

Hi! My name is Alex Stockton. I'm a video journalist with New York Times Opinion and I produced this video. For our reporting, we spoke with more than 50 doctors and patients. They told us horrific stories of being blockaded by insurance companies. Has this happened to you? Let me know about your experiences navigating this system. And I'd be happy to answer any questions. Thanks for watching

[chethanforyou]

If insurance companies are making medical care decisions and patients are being harmed they should be legally liable for malpractice.

[deidaraer]

This is what happens in a country that measures its success on GDP, the stock market, and profit rather than happiness, life expectancy, and human flourishing.

[michelleaguirre]

My dad was diagnosis with stage 4 lung cancer, he lost his battle after 9 terrible weeks. I wish I tracked the amount of time I spent on the phone with his insurance fighting for treatment, medicine and medical equipment. Hours upon hours trying to get things approved, messaging his doctors for them to resubmit the same request allover agian. Having someone you love who is sick and dying is so hard, having to deal with these insurance companies is just cruel. Those hours I spent on the phone I could have spent with my dad, holding his hand, hearing his stories, telling him I loved him. Our system is beyond broken.

[DoubleDee]

The big argument about Universal Healthcare was nobody wanted a panel of bureaucrats deciding wether someone lives or dies or imposing long waits. We now have a private system that does exactly that.

[vandanpanchal]

As a physician, this is the bane of my existence everyday. I didn’t go all these years of medical school and training to do this BS paperwork

[Blaze]

Aren't insurance companies the primary reason healthcare is expensive to begin with?

[MichaelSantangelo]

2 months ago I went to my doctor for recurring pain in my neck, shoulder, and arm. I hadn't injured myself in any way that I could remember. My doctor said, ok, let's get you an xray, and mri, and a nerve test to check for damaged nerves, pinches, broken bones, etc.

My insurance allowed xrays and nerve test.. They denied my mri, telling me I needed to do 6 weeks of 'conservative' treatment which was basically physical therapy. I did the 6 weeks of physical therapy, which has made the pain in my neck WORSE. My doctor says it's definitely a nerve issue, that the mri would have given us a clear indication of. But now I have pain that MIGHT be permanent because my insurance decided that their profits are more important than my health and happiness.

This video is my story, and the story of hundreds of thousands of other Americans. We need to burn this whole system to the ground.

[manfredconnor]

People in the US need to rise up and throw off these insurance companies. They are standing between you and universal health care.

[down-to-earth-mystery-school]

Healthcare should NOT be for-profit, period.

[conservemarine]

Fighting the insurance companies was harder than fighting the cancer I had.

[lycjvbo]

I’m a RN case manager and I was fired from my position when I fought for my elderly patients denial of service

[allisonjones-lo]

On several occasions my insurance has denied diagnostic treatments that my doctor said I needed. Each time I told my doctor to go ahead and do the treatment and if my insurance does not pay, I will. Each time, the treatments proved to be successful and the insurance paid the bill in full. I refuse to put my health in the hands of insurance companies even if I can't pay the bill. I also informed my congressman and senators about these situations. This is how I am fighting back.

[royhsu]

absolutely ridiculous system of healthcare here in America

[KittySheep]

Faces you will never see, people you will never know, get to decide your quality of life, or death, in the name of making rich people even richer. We are fodder.

[lenoraaronel]

I live in Canada. Several years ago I had black spots and flashes in my eyes and I went to the hospital emergency. Yes I had to wait three hours to see the doctor. After my initial exam, he said your retina is threatening to detach, you’re not going anywhere we are calling in a specialist to do laser surgery on your eyes.I waited another two hours the specialist arrived and did the surgery. I paid nothing out out of pocket except for the parking fees.

[lyssavaught]

Primary Care Nurse here ✋️THANK YOU for bringing attention to the insane hoops that insurance requires providers to go through JUST to provide patient care! Nurses and Providers alike waste HOURS daily on prior authorizations and stay super late after the clinic closes to try to complete them just so our patients are able to get what they need!

[KaleighMacKay]

So insurance companies (who aren’t doctors) are the ones making judgements on what a patient needs? Makes total sense

[Jenx]

At $22 billion profit by just one insurance company it’s pretty obvious that insurance owns the government.

[FP]

When I had a major medical problem years ago and saw what had happened to 2 people in my life who died trying to get care, I knew I was going to have to really fight. I didn’t feel good enough to fight for care but I did it. I was not under threat of death. Can you imagine you find out for example that you have cancer, you are very sick and you are having to spend every day of your life fighting and fighting and fighting for care? It’s evil.