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Elisabeth Rosenthal’s May 18 Thursday Opinion essay, “Health-insurance claims failures are on the rise — and getting weirder.”, hit the nail on the head. As a rheumatologist, I see many patients who struggle to keep up with their daily activities and find the treatments they need to manage their chronic pain. Insurers’ prior authorization policies reinforce my patients’ struggles by erecting ineffective barriers and delaying access to the drugs I know are best for my patients. More than 54 million Americans Living with rheumatic diseaseAnd a delay in their care can mean irreversible disease progression and permanent loss of body functions.
Prior authorization, the process by which health insurers require doctors to approve coverage for medically necessary care, has been deregulated. I have seen the volume of requests grow exponentially, forcing many practices, including mine, to devote more resources to hiring staff designed to handle this enormous administrative burden. Often, these requests are delayed and denied by representatives who do not work in the same specialty, meaning that years of medical education, training, and interactions with patients are often arbitrarily erased.
I am grateful that the current administration has taken the first step to make the process more transparent and efficient by enacting laws limiting the use of prior authorization. But more must be done. I urge policymakers and Congress to ensure insurers do not bypass the medical decision-making process and implement solutions to protect long-term patient health.
The author is a member of the American College of Rheumatology.
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