30 Days of US Healthcare: Prior Authorizations

your portrayal of health insurance reps both having 0 empathy and 0 medical knowledge is spot on. ever since i was little my mom and i have had many fun arguments with health insurance representatives over why i should get supplies for my t1 diabetes covered. one time i called them asking why my insulin prescription, you know, the thing my body doesnt make and i will literally die without, suddenly had a rather expensive copay, and i explained that im supposed to get it for free and always have, and this person, word for word, told me "why should you get it for free?" before i snapped back with "because i NEED IT TO LIVE", and then i had to switch to a different brand anyway that worked just different enough to where it impacted my blood sugars. on top of all that, when I was first diagnosed as a toddler, we couldnt even get insurance coverage for anything during the first year or so because of the "pre existing condition" crap at the time.

I have no connection to the medical field whatsoever, and I’m still wholeheartedly convinced that the health insurance industry is not just a scam, it’s a full-blown extortion racket.

Why do you work here, Jimothy? To witness the atrocity, Jimothy. Somebody has to tell.

If prior authorization almost pro forma you've got a problem. The point isn't to see if the patient needs it. The point is to look it up in the table and see if it's covered or not.

This country is trash

Thank you for making this series. 💙💙

When I had my appendix taken out, these vultures tried to deny service with a prior authorization.

Spent nearly an hour on the phone with the devil to get an authorization for someone's retinal detach to be surgically addressed. The only reason I even called is because the website is down.

The website that allows providers to track pending auths. The rep said it would be 10 to 14 business days for a decision. After I told them surgery needed to happen either today or tomorrow. And then when I course corrected the call, they said "well, you should have told me it was urgent."

What does "today or tomorrow mean? Also, it's a detached retina."
"Well, I'm sorry. I dont have medical training." Obviously.

Bonus, they also tried to start the auth before I gave them the facility info. Despite me telling them I was calling from the doctor's office when they asked if I was calling from the provider or facility.

oh well, gee, I don't know. Maybe that whole thing of "Corporations are people" is going to really come back and bite them in the ass when those "people" are seen as practicing medicine without a license?

Fun isn't something one considers when balancing the universe, but this one time, it does put a smile on my face.

It would seem this is a wait it out and hope you die first plan by all US insurance companies. I would be shocked, but I live in the US too.

As a pharmacy technician, nothing is worse than a prior auth. I’m basically quoting this video to explain to patients that even though their doctor prescribed something their doctor also has to submit it’s necessity. ….even for prescription allergy meds 🥲

Does Jimothy quit at the end?

We could go to Canada and while waiting to see an MD.

I don’t miss working on the medical field. P.A. Is probably the one of the most soul ripping process I’ve seen

Why fix a patient physically only to break them financially?

Had this exact thing happen to me when my doctor prescribed medication to help with my daytime sleepiness (literally dozed in the waiting room) and the insurance company jerked me around for a month, refusing to cover it. I finally ended up paying out of pocket for a medication that was several hundred dollars because I couldn't function.

This is why people don't trust their doctors. Time for actual medical professionals to take their industry back and restore confidence in doctors. Do 30 days of pharmaceutical companies next.

THE ONLY COUNTRY IN THE WORLD THAT DOES NOT PROVIDE FREE HEALTHCARE IS THE UNITED STATES! WAKE UP PEOPLE! HEALTHCARE IN THE US IS ONLY FOR PROFIT - NOT FOR YOUR WELL-BEING! THIS IS WHY BIG PHARMA, THE CDC, ETAL., ARE ADEPT AT DECEIVING YOU!

Sad Americans 😢

As a doctor, I cannot imagine working in this type of healthcare system, and this is coming from a doctor who works in Syria! A country that is financially devastated. I work in a public university hospital as a part of my training and even though resources are basically non-existent, every patient gets everything they need. I order a new chest x-ray everyday for a patient who is on chest tube due to pneumothorax. No one questions why I do it. CT scans don’t need approval. If a doctor says the patient needs a CT then the patient gets the CT. And when we need something that isn’t available in the hospital, we contact private hospitals and donor organizations to pay the bill for the patients who can. An MRI costs 40$ here and when patients can’t pay, organizations pay. This is Syria we are talking about! A third world financially struggling country, not the world’s most powerful economy of the US. This makes me sick.

A FOR PROFIT Healthcare system. WWJD? Think about it (and what He did when He found the moneylenders in The Temple).

Honestly I'm interested im Jimothy's backstory. Like yeah why did he apply to work there? What's your villain backstory, man?

I used to work synagis for premature infants as part of a limited distribution team at a specialty pharmacy. I would see twins or triplets all the time, with all the same information except for the name. One would be approved with no problem and the other would be denied or require a prior authorization. For those of you who aren't familiar with the drug, it's used to guard against RSV and to help the babies breath. So, basically, parents of these children, often straight out of traumatic births, would be forced to choose which child got to live longer while insurance decided if cost was worth it. :) because this is America, the land of the free. Well, the land of the free billionaires. Everyone else has to pay for it, often quite literally with their first born.

I literally just had a CT denied TWICE. Second time my doctor did exactly what insurance said they required for approval and they still effing denied it 😤😤😤😤 so now my doctor said f it and he’s going to try to get the images he needs in his surgical suite (he’s an IR). I’m thankful he’s jumping through hoops to help me but also pissed that insurance is getting away with this 😤😤😤😤😤 I should mention, my insurance uses some imaging third party and they are legit criminals.

I ran into this with an MRI. I needed prior authorization to have it done, but they wouldn’t look at it until it was scheduled. So I had to schedule it and hope they figured out their crap before my appointment and risk having to pay out of pocket. They refused to approve the order until it was scheduled. It was ridiculous and stressful.

It’s getting beyond the point when we start reminding the C-suite dick thistles of these companies that we still remember where the torches and pitchforks are.

In Germany, we have a list of things the insurance HAS to pay, no matter what.

The stories I can tell about these prior auth requests 🫤
For example, did you know that if you’re a CEO of some well known company or a well connected person… you can actually get your requests approved pretty quickly? Yes, you just need to escalate it to some VP of your insurance company and they will push it through.

But if you’re a commoner… well, good luck. You’ll just have to go through the entire ridiculous process 😣

Put these videos on TV instead of the continuous pharmaceutical ones!

I suddenly want to see a "health insurance company vs rural medicine" video, see how that turns out.

Aren't congress ppl or biden looking into the iklegality of prior auths so some insurance companies are backing off of it? 🤔

I hate how right you are. My life is now so painful and nonproductive filling out endless forms for PAs of things that I wouldn’t have ordered if they weren’t necessary. And don’t get me (or us) started on pharmaceutical middle management. 😡🤬

It's really scary. The most powerful country provides this to their citizens 😢

This is SO like a “ Pitch Meeting”!

Insurance companies don't insure anything

Was literally on the phone for 2 hours talking to 4 different reps from the health plan and the company that manages the authorizations for that health plan to try and get a copy of the medical treatment guidelines they based their denial decisions on. Suffice to say that I still don't have them.

Jimothy has the tone of a man who is fast approaching the day he submits an informal request for the CEO to self-medicate with alternative euthanasia treatments.

Disgusting country , vile healthcare, uneducated staff

I've been delayed by UNITED HEALTHCARE for my follow-up, routine CT scan, twice, for monitoring for a return of cancer after my successful lung cancer lobectomy because I haven't been able to get authorized. You know... the most common practice for post-surgery cancer patients. (sorry for the bold, just making sure people see it).

If there ever is a collapse of society, my main goal if I'm still alive will be hosting Insurance Executive Hunting Expeditions. They'd be a most satisfying hunt.

OH AND APPROVALS EXPIRE TOO!!!

I feel like the only time prior authorizations should be okay is for worker’s compensation claims since we don’t say they don’t need it if it’s denied but that it’s not related to the work injury. And before you ask, no none of us need to have licenses or medical training. As a claim examiner 8/10 times if I’ve accepted the claim I approve it.

Currently paying 250/month for a specific medication out of pocket because my ins won't cover it without a prior authorization despite covering the immediate release version of it that would leave me unstable. Go insurance!

Sack insurance companies and go the way of European countries.

On the 5th day of September, Dr. Glaucomflecken taught,

Prior Auths practice med'cine with no license!!
Co-payments punish,
Co-insurance varies (but invariably sucks),
Deductibles are scams,
And how monthly premiums make us distraught

Everything my Dr has requested for the last 6 months have been denied and then later approved by my insurance. It's caused delays and forced rescheduling for followup appointments.

Same thing in Brazil.

Today, tried to consolidate a pt’s med list by swapping out the 2 tabs of metformin 500 mg he takes BID for 1 1000 mg tab BID. Rejected. Prior authorization required.

Metformin.

The citizenry of this country needs medical care sometimes, and it is completely unreasonable to allow the middlemen in our healthcare system to be vetoing medicine. The insurance companies should absolutely not be allowed to so deeply interfere in the practice of medicine, and evidence shows it makes people sicker and many of us die; Many Americans die for a corrupt profit scheme, and we can do better.
We do not need to accept such a bad deal, and we need to change to a different system than this.
Since it's breaking before our eyes. Getting worse.
Provoking the need to make different choices about what's important--people or money.
I think it's about time we chose people, an not exclude anyone from care for payment.
We already have the most expensive healthcare system in the world, and this 'luxury model' is a lemon.

As a pharmacy technician I hate prior authorizations with a burning passion

Remember, every day they deny payment for anything means they hold onto that money and collect the interest. That adds up to a ton of money earned every day just for saying "No".