Healthcare is nothing more… nothing less than a FOR PROFIT BUSINESS

I have read stories, that these insurance/pbm companies hire retired physicians to review the prior authorization process. Those articles also stated that those physicians are paid a BONUS based on the percentage of what the insurance/pbm saves from denial of coverage of a specific product or service. These physicians are paid their BONUS weekly.

The physician reviewing a prior authorization may not be credentialed in the specific disease they are reviewing to decide to approve or deny coverage.

SB 516, authored by Senator Nancy Skinner and sponsored by the California Medical Association (CMA) will reform the prior authorization process in California to ensure patients get the treatment they need when they need it. 

The New York Times published an opinion video today, titled “What’s my life worth? The Big Business of Denying Medical Care” that clearly demonstrates how insurance companies use prior authorization to protect profits, putting patients at risk.

To produce the video, the New York Times interviewed more than 50 physicians and patients who have dealt with prior authorization delays firsthand, including Irvine-based pediatrician and CMA member, Eric Ball, M.D., who spoke about how the “peer-to-peer” process for appealing a prior authorization denial can involve speaking with a physician who does not have a relevant specialty.

“I’m a pediatrician and sometimes I’ll end up talking to a neurologist,” Dr. Ball said. “Often times it’s not even a physician.”

Also interviewed were California patients Vivian Gonzales and Ocean McIntryre, both of whom were harmed by prior authorization delays and had courageously shared their stories with the California Legislature last summer when prior authorization legislation was heard in the Assembly Health Committee.

Gonzales, a public health nurse, dealt with multiple denials while trying to obtain care for her father, whom she eventually lost to cancer. “I spent so much time on the phone, writing letters, faxing, that I didn’t get to spend that time with my father,” Gonzales said in the video.

And McIntyre, a space science communicator, lost her eyesight as the care she needed was delayed for months due to prior authorization. “I finally got the authorization to see the neuro-ophthalmologist after 12 weeks, and he said, ‘We’re going to do this surgery, but it’s only to preserve the vision you have left. If we had seen you earlier, that would have been a different story,’” McIntyre said in the video. “Maybe I’d be able to see now. Maybe I’d have a different life.”

This year, CMA is sponsoring SB 516 to reform the prior authorization system and ensure patients get treatments they urgently need without unnecessary delays. Over the course of this legislative session, be on the lookout for updates and further communications regarding SB 516.

Share Your Story

CMA physicians have staunchly advocated for prior authorization reform by sharing personal stories and stories from patients about harmful care delays and denials; speaking to local media about the need for prior authorization reform; and submitting video testimonies about the impact of prior authorization. Patient witnesses also shared harrowing testimony in legislative hearings and through media outlets about the devastating impacts prior authorization delays have had on their lives and their loved ones.

CMA urges physicians to continue to share stories about the harms of prior authorization delays – both from your own experiences and practices, as well as from your patients. Together, we can win this fight and create a better system that prioritizes patients over profits.

3 Responses

  1. Thee exact words of my last appointment old primary was,,”Its no longer about patients well being,,its only about the $$$$$,” thus why he was done,,retiring,,at 68,,,Great Doctor,,,another good one,,,,gone,,Now my new primary,,she owns her own little clinic,her and a few other doctors.They are not obligated to follow the rules of the big hospitals,,Also just recently,,my hubby,,got lymes,,but he went to a ,”free clinic,” run by all ,”older doctors,’ still liscenced,,but it is free,,,Of course if u need x-rays and stuff u gotta pay,,but they have found indepenedent mri’,,x-ray etc folks who charge like 50 bucks for a chest x-ray,,,no insurance billed,,These are all Doctors who should be retired…The Doc he saw was 72,,female,,,but charged him nothing,,where as if he went to a emergancy care it would of been our out of pocket/deductable 1st,,,then they’d start payen..It was nice,to see these older doctors,,doing what they alll signed up for,,,,40 years ago,,,simple helping the sick,,,,for free,,,no insurance billing,,nothing,,,,There hours are only 2ce a week,,,7 am till 2 pm,,and thats it,,1st come ,,1st served,,,and I REMEMBER THAT AS A KID w.our old doctor,,when it was 15.00$$$ for the surgery room,,to get my tonsils out,,,those were the good ole days 4 sure,,,jmo,,,maryw

  2. Who is here to protect the US LEGAL citizen from this travesty? No one!! Although illegal aliens, criminals and politicians are all protected. We have to come together, throw down any differences and confront the “real enemy” in addition to the Federal Reserve. We need to close Congress permanently. They have become a cesspool for abuse not doing anything except accepting anything valuable from Pharma/Biotect/PBM/Chain Pharmacy lobbyists. Enough of this bs, citizens collectively must take action, even with pitchforks and torches NOW! And why are any of us paying taxes? Look where the 3 trillion plus per year from US citizens are going to? They want to destroy all this country stood for throughout the world.

  3. I agree, especially the Medicare part D groups. Any more we just can’t assume the physician will “do no harm” like past times. Rather, the “Baby needs a new pair of shoes” method is used as a methodology when a surgeon decides to operate, schedule prescriptions or whatever they choose. We just can’t assume we are being treated by competent doctors who are passionate about anything but the almighty dollar.

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