Kayla’s Story

I work in a medical practice and have been working on prior authorizations for medications for over five years. With the exception of a few insurance companies being proficient and easy to work with, a majority of insurance companies make it extremely difficult to obtain an approval for medications for patients in a timely manner — especially when it comes to biologic medications. Every company has their own preferred alternative so it is never consistent or the same when I complete a PA for a biologic. Once a prior auth is denied, then an appeal needs submitted and can take up to 45 business days to reach a final decision. This is a long time for patients to wait for even a possibility of their medications being approved. In this time, patients continue to suffer from their diagnosis until insurance reaches a determination. If denied again, then we have to start the PA process all over with a new biologic in the hopes that this one will be covered. It is a completely inefficient process for all parties involved, and delays proper care for the patient. The whole point in seeing a doctor is that the doctor determines what is medically necessary or appropriate for the patient, not the insurance. Prior auths for medications and procedure delay proper care.