Is Insurance Evil?

In this video, I share how insurance denials harm people with Multiple Sclerosis. Is health insurance prior authorization evil? What is the prior authorization process? What is Prior Authorization??

The Boster Center for Multiple Sclerosis accepts new consultations and is actively enrolling several MS clinical trials! www.BosterMS.com or call 614-304-3444 to schedule!

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COMMENT with your thoughts and questions below! I look forward to reading and responding!

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NOTE: Make sure to talk to your provider before ANY treatment decision. We hope to educate, empower and energize those impacted by Multiple Sclerosis. This channel consists of a collection of formal lectures and informal video clips about MS to help educate others. These videos do not provide medical advice and are for informational/educational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any of our videos. They are just to help educate you about the condition guys!

[beckymoran]

I do medical billing for a living. I know the in’s and out’s of insurance tactics. Even I have such difficulty with insurance. I can’t believe some of their terrible medical decisions. Yes, medical decisions. Practicing medicine without a license, messing with our lives. It happened to me. Prior authorization took forever, and then was denied. Unreal!

[LSClarke]

When I was first dx with multiple sclerosis and was seen by a neurologist, he suggested I go on Ocrevus. My insurance (Medicaid) denied it, but the neurologist made sure he sent an explanation on why I needed THIS medication. They approved it. I decided then that he would be my neurologist even though it is about an hour away from my house.

[fd]

My daughter began the investigation in August. By the beginning of September, there was no doubt she had MS. Shortly after, she received her first Tysabri infusion at the national MS center, followed by the first dose of the hepatitis B vaccine. By March, when she receives the final dose, she will transition to Kesimpta.

We live in Romania, where we have a national insurance system. While there are private insurance companies, contributing to the national system is mandatory. The medical system here faces many challenges, so receiving the treatment without any issues was a pleasant surprise.

We have spoken to some patients who have been on treatment for years, and they all received it on time. I hope this will continue to be the case.

[FUMSvideos]

This is a HOT BUTTON with anyone in the U.S. that deals with health insurance. Thanks for always finding ways that we can help ourselves and feel empowered!

[meach]

I am fully living this experience. Denial after denial, even with private insurance.

[Jenny-rmqo]

This happened to me. They took time to approve. Then in end December they approved. Scheduled first treatment earlier January. They denied me. Changed their approval and said I need to do other thing first, took till February to get the other medicine that the neurologist said wouldn't really help me. New MS and no history so they gave me the run around. It was a Hugh battle. I was my advocate. I was able to get the infusion the neurologist wanted me to take by April. A long wait from October the previous year.

[CarissaLeeVlog]

Thats just horrible! Thank you for sharing this startling study. A month ago, a fairly new friend of mine saw me struggling to walk at a work event (still not diagnosed) and came to check on me. Turns out, her mother died from MS after they discontinued her treatment because insurance said she was maxed out. She was dead one year later and it truly breaks my heart. I hope things change in the medical industry for MS patients.

[athenasheffield]

Unfortunately, insurance has been the bane of my existence since being diagnosed in 2011. I've had more medication denials by the insurance company than approvals where my MS is involved. The company acts as if they know more about my health than my neuro, who spends approximately 45 minutes to an hour with me at my annual appointments. My neuro has a medical degree and often specializes in MS, has the medical experience to evaluate my MS, allows me to vocalize and be my own advocate, AND is in my corner. We have a Blue Cross Blue Shield facility (I don't know what to call it....compound or branch or facility or...?) and I know for a fact that the entry level workers (the people who take our phone calls and transfer us all around) only need a high school diploma or GED to apply.

Health insurance in America definitely needs an overhaul, especially for people with lifelong chronic diseases!!!

[aocm]

Thank you for fighting with us Dr. Boster! 🥰

[willsoliman]

Insurance restrictions often create significant barriers for patients and healthcare providers, impacting timely access to optimal treatments. Excellent work highlighting the real-world implications of these policies!

[KaiceyW]

Thank you for speaking about this and for sharing this article. As someone who works in medical billing, I know all too well how frustrating insurances can be from both sides. My insurance just started a program that could impact my access to treatment, so this video couldn’t have come at a better time. Even working in billing and knowing all I do, dealing with insurance can be a nightmare. They seem to all interpret and apply the “rules” differently and as they see fit. They bank on people not knowing how their insurance should work or giving up on fighting them. Like you said, time is brain and this stuff is nothing to play with. These companies should have no say in people’s medical decisions. That should be left to the medical professionals to deem what is necessary. I really wish there was a solution to this problem. As long as there is money to be made, our health and well-being will be the last priority in the “healthcare” discussion. I can only imagine how frustrating that must be from your perspective.

[krebsfamily]

My diagnosing doctor put me on a lower efficacy dmt that my insurance would approve despite my imploring her to try for Ocrevus. I want to publically thank you for telling me that was BS on the dirst day I met with you at the Boster Center when I came for a second opinion. A week later, your amazing team had me scheduled for Ocrevus. I am forever grateful for your advocacy and unwillingness to take no for an answer!

[DotHacker]

I had 2 bad experiences with private insurance. When I got a sudden life changing relapse that made me wheelchair bound my doc gave the orders for me to get emergency treatment in a hospital that day. Insurance denied the hospital claim because there was no PA before I went; it was an emergency. When NC Medicaid switched from public to managed care plans, my private health insurance denied my DMT Ocrevus for FOUR MONTHS! That's 10 months since my previous dose and I could have had a serious change in condition because one of the top US insurance companies wanted to fight my doc and save some money. Thanks doc for making this video and cultivating a place of discussion about the topic

[trudibakken]

Thank you so much for this. Perfect timing. My insurance denied my kesimpta 2x and i am constructing my own appeal letter. I am going to included this report. THANK YOU THANK YOU THANK YOU.

[rogerfortier]

I'm in Canada. SunLife screwed around with me for 6 months and would never tell us why. Good thing Biogen would keep giving me my Tysabri while we kept pushing.

[jonplaud]

Insurance companies DO NOT CARE. We are just a number.

[jennifermontgomery]

Thank you Dr. Boster! After an initial denial, your amazing crew fought for my RX and it was approved. Am looking forward to year 1, month 2 of Mavenclad.

[Adia_Nutrition]

Dr. B Excellent video as always! I would love to do a pod cast with you. Adia Nutrition is the ONLY clinic in the US performing HSCT outside of clinical trials. Doctors like you can assist in making insurance companies pay for this procedure.

[Stiller.Permaculture]

I didn’t have much issue with insurance. Twenty years of missing the diagnosis did extra damage though. Only when I was in terrible shape was the disease caught.

[mikenicoletti]

Thanks Dr B! I had insurance delays shortly after diagnosis and I got more frequent relapses. I'm on Ocrevus now and it's really helping me