The Struggle with Health Insurance Authorizations for Disability and Chronic Conditions
I don’t know about you, but the older I get, the less patience and tolerance I have for dealing with health insurance companies. Unfortunately, because I have a disability and live with multiple chronic health conditions, I can’t avoid what I call the United States for-profit medical industrial complex.
Because it is for-profit, unfortunately, patient care and concern, and—dare I say, customer service— is on the bottom of the list of priorities for health insurance companies. I actually have a fairly grim disposition on the whole situation. I think of navigating health insurance as a “survival-of-the-fittest” endeavor. Those who are the “fittest” (either because of power, privilege, or just plain stubborn) will survive. The rest, well, good luck.
The fact is, for those living with chronic health conditions or permanent disabilities, maintaining an optimal quality of life often hinges on access to a spectrum of healthcare services and medications. However, the gatekeeper to this realm is frequently a daunting and relentless bureaucracy—prior authorizations and their not-so-distant cousin, re-authorizations. These processes can feel like an endless loop of paperwork, proving over and over that yes, you still need that medication or therapy that you've been on for years. I’m always baffled when my husband who has used a wheelchair for his whole life has to get re-authorizations for his new chairs as if he was just newly diagnosed.
It can take weeks or months to start treatment once a doctor gives their diagnosis for a health condition. Not only can it take a long time just to get into see a doctor, especially if it is a specialist, but once they order tests or medicines, waiting for insurance approval can be nerve-wracking. Not knowing if or when you'll get the green light for essential treatments can exacerbate stress and anxiety. And let’s not forget that typically when you have to seek medical help, you have the least energy or wellness to fill out extra forms, make numerous phone calls, and coordinate your care between your doctors, pharmacies, and insurance company. But even if you are having to jump through these hoops in a relatively healthy state, it’s time that could be better spent attending to other important demands of your daily life.
Additionally, delays in authorizations can lead to interrupted treatment, affecting disease management and quality of life. For those with chronic conditions or permanent disabilities, consistency in care is not just preferred; it's crucial. The hidden costs of the authorization process, from lost work hours to unexpected out-of-pocket expenses when treatments are temporarily uncovered, add an extra layer of financial strain. Unfortunately, insurance companies try to put the onus back on to patients. They try to frame today’s healthcare landscape as a traditional consumer-oriented experience. This attitude does nothing to motivate them to try to change their behavior for the better.
I once had an insurance benefits specialist tell me that going to get a diagnostic test like an x-ray was analogous to going to buying a pair of shoes. I was speechless. (And that doesn’t happen very often) The most glaring problem with this comparison is that when I go to buy a pair of shoes, I actually know what they cost. Today’s medical costs are shrouded in complex formularies and price indexes that make it nearly impossible to know what a test actually costs. I challenge anyone to take a look at a recent Explanation of Benefits from their insurance company and feel confident that they understand a) exactly what their benefits are and b) how much a diagnostic or office visit costs.
The reason I am addressing cost in the context of health insurance authorizations is because the reality of healthcare in the United States is that it is a capitalist enterprise. Getting your insurance company to authorize a treatment comes down to how expensive it is. But how can a patient ever feel like they are a level playing field to advocate for themselves if there is no transparency in pricing? And don’t even get me started on who is making the authorization decisions for our care. I don’t feel like it is spoiling things to tell you that more often than not, it is not a healthcare professional.
Advocating for Change
Because there is a lot to be legitimately frustrated about when it comes to health insurance authorizations, it makes all the more reason to advocate for a more just, humane system. It is important that people who have to rely on healthcare in their daily life push for substantive policy changes. Patient advocacy groups and social media campaigns can be powerful tools in this fight. Many policymakers may not be aware of the depth of the problem. Providing them with real-life examples and data on how these processes affect individuals can spur legislative action.
One example of a solution is the implementation of more streamlined, technology-driven solutions that can quicken the authorization process. Additionally, on a personal, proactive level, being well-informed about your rights and the details of your health insurance policy can equip you to better navigate disputes and delays. As admittedly exhausting as it is, keeping a communication log and paperwork of all of your interactions with your medical providers and insurance company will detail your journey of securing the services you are entitled to in your policy.
The bottom line is that seeking medical authorizations and re-authorizations for disabled and chronically ill people is much like Groundhog Day, but with paperwork, phone calls, and the ever-looming anxiety over whether your essential treatments and medications will be covered this time. This cycle isn't just a nuisance; it's a significant barrier to continuous and effective care. By understanding the challenges in the system, and then advocating for patient-centered improvements and reforms, we will turn our frustrations into fuel for change, ensuring that we will not only survive our health system— but thrive.