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Elisabeth Rosenthal’s May 18 Thursday Opinion essay, “Denials of health-insurance claims are rising — and getting weirder,” hit the nail on the pinnacle. As a rheumatologist, I see many sufferers who battle to maintain up with their day by day actions and rely on entry to mandatory remedies to handle their persistent ache. Insurers’ prior-authorization insurance policies amplify my sufferers’ battle by constructing ineffective hurdles and delaying entry to drugs I do know are greatest for my sufferers. More than 54 million Americans live with a rheumatic disease, and delays of their care can imply irreversible illness development and everlasting lack of bodily features.
Prior authorization, the method by which well being insurers require docs to request protection approval for medically mandatory care, has gotten out of hand. I’ve seen the amount of requests develop exponentially, forcing many practices, together with mine, to dedicate monumental sources to rent employees particularly devoted to coping with this monumental administrative burden. Often, these requests are delayed and denied by representatives who don’t work in the identical specialty, that means my years of medical schooling, coaching and relationship-building with sufferers are sometimes arbitrarily overruled.
I’m grateful the present administration has taken step one to suggest guidelines that will restrict the usage of prior authorization, making the method extra clear and environment friendly. But extra have to be carried out. I urge policymakers and Congress to implement options to cease insurers from overtaking the medical decision-making course of and shield long-term affected person well being.
The author is a member of the American College of Rheumatology.
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