What is the prior authorization process for health insurance?

Prior authorization requires patients or their doctors to get preapproval from health insurers before receiving medical care, and it often leads to denials.

How long did Sheldon Ekirch fight for her medical treatment coverage?

Sheldon Ekirch fought her health insurance company, Anthem, for two years to get coverage for blood plasma infusions.

What challenges do patients like Payton Herres face with insurance?

Patients like Payton Herres face insurance denials for essential medications they have been taking for years, creating a scramble to secure coverage.

Home / Health / Patient Fights Insurance for Lifesaving Care

Patient Fights Insurance for Lifesaving Care

11 Mar

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Summary

Patients face repeated insurance denials for essential medical treatments.
Insurers pledged reforms but specifics on changes remain elusive.
Prior authorization remains a significant barrier to necessary care.

Patient Fights Insurance for Lifesaving Care

Patients across the United States continue to face significant challenges with health insurance prior authorization processes. Sheldon Ekirch, from Henrico, Virginia, finally secured coverage for intravenous immunoglobulin (IVIG) after a two-year battle with Anthem, which had repeatedly denied the costly treatment. Her parents had spent approximately $90,000 out-of-pocket while awaiting approval.

Despite pledges made in June by health insurance leaders to simplify prior authorization, many companies have failed to provide specific details about services no longer requiring preapproval. Physician groups and patient advocates express pessimism about voluntary changes, suggesting that insurers prioritize financial interests over patient well-being.