Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
My friend just went through this recently.
She had significant sinus problems, one side being blocked entirely. Went to see her doctor, went to see a specialist, tried some things, but what she needed was surgery to get rid of polyps. She schedules it, takes off of work, gets a blood test, goes to the surgical center, and as she is being prepped for surgery, finds out they have to cancel, because her insurance was denying a part of the procedure.
What a huge fucking waste of time and money.
She did get a reason in the rejection letter, but it just pissed me off even more. The insurance company has a “doctor” who said the procedure might not be necessary, so they want to try doing X and Y first. Things she’s already done. Things her PMC doctor and specialist already know, but this one asshole who sold his soul to an insurance company gets paid to skim shit and say “no.” There are plenty of people in the insurance company structure to hate, but some of them are outright scum.
Also, to state the obvious, this is just slowing down the misery machine, when we should be dismantling it. I know it will help people, it’s a small victory, and the Republicans will want to turbo-charge said misery machine, but still.