An insurance company denied coverage to a newborn in a neonatal I.C.U. The rejection letter was directed to the newborn. It stated, "You are drinking from a bottle. You are breathing on your own." An insurance company denied an urgent heart transplant because the hospital was out of network. The cardiologist called out the company on social media: "You apparently would like us to transfer to another I.C.U. in a hospital out of state and hundreds of miles away where the patient has no family, no resources and no support. Are you also then going to cover housing and transportation costs indefinitely post transplant?" An insurance company denied a lung transplant for a mother with Stage 4 cancer — her last hope for survival. Only after they were criticized on social media did the insurance company reverse course. As part of my work as a video journalist with Times Opinion, I have traveled across the country documenting the biggest issues in American health care and trying to find solutions. For my latest video, published today, I set out to understand how insurance companies are able to get away with such plainly egregious behavior and what, if anything, can be done to bring them to heel. I spoke to doctors, patients, experts and a former insurance company executive. They pointed to a seemingly trivial bureaucratic process that requires doctors to get permission from insurance companies before they can provide many treatments. It's been around for decades, but recently, it has spiraled out of control, too often creating deadly delays and inflating health care costs. It's called prior authorization. In the video, doctors and patients share their prior authorization horror stories. They reveal a medical system flipped on its head — doctors turned into unwilling puppets of the insurance companies, who are more motivated by profit than by the Hippocratic oath. Fortunately, a few states may have found a solution. Watch the video to find out more:
Here's what we're focusing on today:
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Thursday, March 14, 2024
Opinion Today: Medical injustice, disguised as paperwork
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