My Experience with Prior Authorization

‍

As a person living with Parkinson’s disease, I have firsthand experience with the difficulty of obtaining prior authorization from insurance companies. It seems like every time I need a new medication or medical procedure, I have to jump through hoops just to get my insurance company to cover it.

Prior authorization is often required by a health insurance company when they question whether a medication is indeed medically necessary. The process usually starts with my doctor submitting a request for prior authorization. He will need to clearly and adamantly state the reasons why I must have this exact medicine and not something similar, and provide clinical evidence with it. Oftentimes patients have to change medications and try other therapies before they even get close to approval. Fortunately for me (or not) I have already exhausted the small amount of options available and have concluded that what I take is the best that medical science can do for me at the moment.

Then, I wait for days, sometimes even weeks, to hear back from my insurance company. During this time, I'm left wondering if my treatment will be covered and if I'll be able to afford it. Recently, I was only notified that my prescription had been rejected when my neurologist’s office called me and wanted me to schedule an earlier appointment. I would have been waiting in vain for my refill if they hadn’t, and with Parkinson’s, this is incredibly detrimental.

It was also concluded in the insurance company's review that it was indeed NOT detrimental for me to be off this medication suddenly for any reason that my doctor had provided and therefore They decided they had until April 8 to review and then decide my fate. They were playing the lottery with neurochemicals that I desperately need just to have the opportunity to appear and feel normal.

Even if my request is approved, I often have to go through the process all over again when it's time for a refill or follow-up procedure. It's a never-ending cycle of paperwork, phone calls, and waiting, and the outsourced, poor quality, customer service is not helpful in any regard. And if my request is denied? I'm left with the choice of either paying out of pocket, which for me is upwards of $2000/mo for 2 medications; or going without the treatment I need. It's a difficult and unfair decision to have to make, especially when my health and wellbeing is on the line.

I was fortunate enough that my neurologist was able to provide enough samples of my medication to hold me over, but not until after I endured a painful and scary 33 hour withdrawal process, which only allowed me an hour's sleep. It then took me almost a week to get back on track with my medication.

Overall, the process of obtaining prior authorization from insurance companies is a major source of stress and frustration for patients like me. I turned to social media to create awareness of this issue and publicly call out my insurance company's sub-par business practice and protocol. That was when they decided to cooperate and I received a call from their corporate office asking how they could help. It’s outrageous that someone would have to go this far to protect their health and leads me to question how someone who was in worse health than I would fare in comparison.

I hope that in the future, insurance companies can find a way to streamline this process and make it easier for patients to get the care they need because this process is not working and should not be allowed to exist solely to provide cost-cutting measures to insurance companies.

‍

About the Author: Melissa was diagnosed with Parkinson's Disease in August 2020, and has been advocating for herself and others with Parkinson's since then as a way to bring hope to herself and others. She is credited with starting a hashtag on Instagram and Tiktok, #ParkinsonsLooksLikeMe, and works with the Gray Strong Foundation.

‍