North Carolina resident Sally Nix has had enough with prior authorizations.
Afflicted with a combination of autoimmune diseases since 2011, brain and spinal surgeries failed to relieve Nix’s chronic pain and fatigue. The only treatment that helped her symptoms were intravenous immunoglobulin infusions (IVIG). “IVIG turned out to be my great hope,” she told KFF Health News.
Imagine Nix’s surprise, then, when her health insurer started denying payment for the treatment — all in the name of prior authorization. Without insurance, IVIG would cost more than $13,000 every four weeks. Because she couldn’t afford it, she was forced to pause treatment.
But rather than sit back and wait for her symptoms to get worse, Nix got online.
“There are times when you simply must call out wrongdoings,” Nix spoke out on Instagram. “This is one of those times.”
If you’ve been around Un-covered awhile, you know that prior authorizations are somewhat of a passion project of ours. Prior authorizations are decisions (err, hurdles) made by your health insurer that determine whether your treatment is “medically necessary.” Prior authorizations often delay patient care and lead to worse outcomes, they cost providers precious time in dealing with paperwork, and they undermine the doctor-patient relationship, as patients can’t get the treatment that their doctors determine is medically best.
Nix isn’t the only one raising hell about prior authorizations online. She is in good company with other patients and providers speaking out.
“Customers are increasingly using social media to air their complaints across all industries, and companies are paying attention,” according to the article.
And it’s making a difference — after KFF Health News contacted Nix’s insurer, Nix found that $36,000 of her outstanding claims were marked “paid.” Her hospital also told her that her insurer will no longer require her to obtain prior authorizations before her infusions. No one told her how or why, but we have a feeling speaking out made a difference.
