Waiting for prior authorization almost killed me

[erronis]

https://vtdigger.org/2026/06/07/opinion-waiting-for-prior-authorization-almost-killed-me/
Walter Carpenter

When insurance companies delay life-saving treatment, patients pay the price.

The recent commentary in VTDigger regarding prior authorization was spot on. Prior authorizations are indeed "prior aggravations" for both patients and physicians. As a patient who nearly lost his life from such aggravations 20 years ago, I know firsthand what this means. Thousands of other Vermonters know it too: Insurance companies are practicing a very real form of healthcare rationing, not based on medical need, but on corporate profits, even as they try to convince us that prior authorizations are to prevent waste and protect patients.

The physician in the commentary described wasting hours arguing with insurance company representatives who had never met the patient and often lacked expertise in the condition being treated. It was the same for my physician and me. My employer-sponsored out-of-state insurer required prior authorizations before each procedure. This led to weeks of denial, then appeal, then denial, then a re-appeal, all of which took time I did not have. I was dying from liver disease -- my skin turned sickly yellow, then ashen gray, and when I needed speed, all I got was nonsensical aggravation and delay.

The interminable wait for the insurance company's permission brought me inches from death. It's only luck that it was finally granted in time for successful treatment. Innumerable other Vermonters have been through the same thing. We can all tell vivid stories about the anxieties and the fears caused by never-ending delays, as illnesses worsened while we fought the health insurance companies for permission to access care we'd paid them dearly for. They call this healthcare efficiency. I call it administrative rationing.

What makes this even more infuriating is that our premiums rise every year, along with the insidious deductibles foisted on us to further ration our access to care. We all know Americans already pay more for healthcare than people in any other developed nation on Earth. So much of these costs are to pay for a private insurance bureaucracy so massive that patients and physicians are obliged to spend days and weeks embroiled in endless fights over prior authorizations.

There is a much deeper question in all this. What is it that we as a state value more: profits or people? This is not just about reforming prior authorization rules. It's about why we allow private insurance companies to have the power to override doctors in the first place.

. . .

[Midnight Writer]

1. Nationalize health insurance and this bullshit goes away.

[Bayard]

2. I think its purposeful

Its much cheaper to let a person die, than to keep paying their medical costs. It is an industry without empathy or conscience, and they are not being reeled in.

[erronis]

3. And when the patient has enough money, keep them alive long enough

to empty their bank accounts before the funeral industry gets the remains.

[Blue Full Moon]

4. That's the point

Right there with dragging out getting social security for disabilities.

[progressoid]

5. USA USA U...

[Orrex]

6. Years back, my wife needed an MRI.

The only appointment available was at 6:30AM on a Saturday.

In the days before the scan, I called the insurance company for pre-approval. They told me that they couldn't give approval until after the scan was taken, to know if it had been justified.

The difference was a $20 copay or a $1400+ bill for the scan, and my insurance company declined to tell me one way or the other.

"Just call to check in the morning before the scan," said one agent.

"You'll answer at 6:00AM on a Saturday?"

Of course not.

[erronis]

7. They are going to wait to see the results of a diagnostic scan to decide whether to pay?

That's absolutely outrageous. I can see at least a couple of ridiculous rationales:

- If the scan is positive and probably life-threatening, don't pay since the patient won't be around long enough to make a lot of future insurance payments.

- If the scan is negative, then don't pay since it was a typical hysterical patient. Can't encourage that, can we?

[Orrex]

8. I had some impolite words for the agent who gave me that answer

Their argument, in brief, was that they wouldn't pay if the scan were deemed unjustified (by a negative diagnosis).

Of course, there was no way to know the diagnosis before the scan, so...

It's such a cruel system. Thankfully our situation worked out ok, and they wound up covering the cost, but how many millions don't fare so well? How many people simply avoid treatment or diagnostic procedures due to cost or the uncertainties of cost?

We all have those stories!


More recently, I had to do a 24-hour pee test, for which they provided a special jug.

$450 later I learned that they gave me the wrong jug, treated with different chemicals, so they weren't able to run most of the intended tests.

"No problem," they said. "We'll provide another jug."

And bill me another $450? Fuck you very much.

[bmichaelh]

9. My experience with cancer treatment preauthorization

Sorry what you and anyone has to go through with preauthorization in this country.

I was first diagnosed with lymphoma in 1990.
It returned in 2002 and 2019.

In 2019, I went through four different treatments over 2 years; they all failed.
The fifth treatment was initially approved; it showed promise as the lymphoma impacted my mobility and slowly I began able to walk more and more.
Then, the insurer sent a letter denying all future treatments.
I was fortunate that the appeal was successful.
I reached complete remission.

Unfortunately, I have maintenance treatments every 3 weeks.
They cost just under $1 million/year.
I think that was the major factor in their decision to deny treatment than anything.

The insurers deny treatments everyday that can possibly save lives.

Trump and the current GOP will not do anything in regard to needed insurance reform.

[erronis]

10. You have definitely seen the underbelly of the med-insurance racket. Glad you're in remission!

I just started a leukemia treatment that is "billed" at $18,000/month. Fortunately the diagnosing hospital mentioned that there are grants (Blood Cancer Society) that covered the first month's out-of-pocket payment which then put me over the yearly maximum. Now all of my Medicare deductible is covered (also using supplemental.)

That "$18,000" would theoretically be what I would have to pay if I was totally uninsured. I'm sure the actual amount that changes hands in the good-old-boy network of pharma/insurers is very different.

[bmichaelh]

11. Grants are very helpful

Good luck.

Before I went into maintenance; I took another drug with my current treatment, called Revlimid.

It lowered my WBC so that I needed another drug called Zarxio.

I applied with and got grants to pay for these drugs.

[Staph]

12. Back in 2017 I had severe anemia, associated with the return of my cancer.

Blood in my stool, so I had both a colonoscopy and endoscopy. No sign of an ulcer. My doctor wanted to use a swallowed camera to find the problem, but Blue Cross / Blue Shield refused to pay for it. Two weeks later, I collapsed on the way to the bathroom in the middle of the night. I was so weak that I couldn't even sit up on the floor. We had to call an ambulance - my hemoglobin was 3.5. I should have been dead. I spent two weeks in the hospital, which BC/BS paid for, in place of paying $2000 for the camera.

As soon as I hit Medicare age, I dropped BC/BS. I will never give them another dime!