California should end this health insurance tactic delaying urgent treatment
This story appeared on Calmatters
In summary
Many Californians in need of urgent health care services often face delays because of an insurance protocol known as prior authorization. A bill in the legislature could reform prior authorization rules so it no longer acts as a barrier to essential treatment.
Guest Commentary written by
Ocean McIntyre
Ocean McIntyre is a space science communicator in the Los Angeles area.
In 2008, I began rapidly losing my vision from a condition called Idiopathic intracranial hypertension. I eventually lost my independence, my ability to work and, ultimately, my life as I knew it.
But it wasn’t just the condition itself that led me to lose my eyesight. It was also the countless delays to obtaining treatment I encountered, thanks to so-called prior authorization. Prior authorization is the process health insurance companies require before they approve medical services prescribed by health care providers.
For many patients, they are simply delay tactics. In my case, these delays kept me from the care I needed as my brain essentially crushed my optic nerves.
I continue to live with the effects of prior authorization. If I had been allowed to get the treatment I needed when I needed it most, I would still be able to drive a car, fly a plane, look through a telescope, see colors or walk without a cane.
But I can’t. I can never do those things again.
This broken process could be fixed if the legislature passes state Sen. Nancy Skinner’s proposal, Senate Bill 598. The bill would grant a one-year exemption from prior authorization to physicians who practice within the scope of a health plan for at least 90% of the time.
My trials with prior authorization began as soon as I received my diagnosis. My doctor requested an urgent authorization to see a neuro-ophthalmologist, but the authorization was denied. He put in another, and it was denied again. Then again.
I spent so much time calling to find out why the authorizations weren’t approved that I developed a relationship with my medical group’s nurse case manager, who was equally frustrated by the denials. I can’t tell you how many times we sat on the phone and cried together.
Learn more about legislators mentioned in this story
Nancy Skinner
State Senate, District 9 (Oakland)
Nancy Skinner
State Senate, District 9 (Oakland)
For more than 12 weeks, I did not get approval for that urgent authorization. During that time, there was nothing I could do. I couldn’t pay out-of-pocket because of the rules that existed. I was stuck.
By the time I finally saw a neuro-ophthalmologist, I could barely see. He told me that I needed to have surgery and that my best hope was to not lose any more vision. It still took two weeks to get authorization for that surgery, even with all his prodding.
Later that year I had brain surgery, and the neurosurgeon told me he didn’t think I would ever be able to have a normal, independent life again based on what my brain looked like.
My recovery was long and excruciating, made worse because of the time I had to wait for care. The hardest part was that my 7-year-old experienced it along with me. I became a shell of the person I was.
We were homeless for a period when I could no longer work.
It took 10 years, but I was eventually able to get a full-time job again. I now have my dream job, working on a major space mission.
But it hasn’t been an easy road, and I still have my problems stemming from my delayed care. Just last year I had to have the shunt in my brain replaced again.
My experience is not unique, either. There are countless others who have gone through similar experiences and worse with prior authorization. Being denied care so frequently made me feel like I wasn’t important – that my life wasn’t important.
It shouldn’t be that way. I hope we can pass SB 598 and reform prior authorization. Health insurance is supposed to be there when you need it most.
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