By Hannah Garden-Monheit, Senior Fellow
The practice of health insurance conglomerates requiring prior authorization for medical treatment — in many cases, medically necessary treatments — and their corporate affiliates then adjudicating those requests for coverage has become not just a massive, costly barrier between patients and the care their doctors prescribe, but one that threatens the health and lives of patients. In a new report, Economic Liberties calls for banning prior authorization as it exists today, rife with conflicts of interest. We document how the practice erodes care quality while inflating costs.
In conjunction with the report, co-author Hannah Garden-Monheit, a senior fellow at Economic Liberties, published an op-ed at MS NOW, recounting how her own father paid the price for needless denials:
Last year, when I called UnitedHealthcare to ask why it had denied prior authorization for my father to enter rehab after the amputation of his leg, the call-center worker sounded as horrified as I was. “This is unreasonable, but I don’t know how I can fix it,” she told me.
My dad’s care team at the Johns Hopkins Hospital had prescribed a short, intensive rehab program built for amputees, but first we needed the pre-approval UnitedHealth requires before patients can receive certain care. That process proved to be a bureaucratic maze of dead-end paperwork.
The first insurance denial cited his cancer, apparently without registering that his leg had just been removed, the whole reason he needed the rehab. The second denial said he didn’t qualify because of his progress; that “progress” was learning to hop on one leg from his hospital bed to a chair. My father’s doctors fought for his care alongside us; collectively, we spent dozens of hours trying to find anyone at UnitedHealth or its affiliate NaviHealth with the authority to make an informed, rational decision…
Read her full article on MS NOW.