🔥 Spoiler Alert: "Prior Authorization" Is Healthcare's Most Weaponized Word 🔥
Ask a doctor what it means? "Medical review."
Ask an insurer? "Cost management."
Ask a patient? "Death sentence."
36% of oncologists say prior auth has led to patient deaths. 80% say it's caused disease progression. 96% say it delays treatment. That's not opinion. That's ASCO surveying 300 cancer doctors who watch their patients die on hold. (Source in comments)
Prior auth was supposed to prevent unnecessary procedures. Now it prevents necessary ones.
87% of cancer patients get denied their oncologist's first choice therapy. 93% are forced to second choice treatments. 74% end up in the ER or hospitalized because of delays. 64% abandon care entirely.
Read those numbers again.
Here's three models of prior auth abuse i've watched kill people:
1) THE STALL: Approve after maximum legal delay. Patient deteriorates. Treatment becomes less effective. Insurer saves money on worse outcomes.
2) THE SHUFFLE: Deny. Appeal. Approve lower tier drug. Fail. Appeal. Approve original drug months later. Call it "step therapy." Patient calls it torture.
3) THE GHOST: Auto-deny anything over $10,000. Force peer-to-peer. Schedule it three weeks out. Doctor can't make the window. Claim denied for "non-participation."
The average prior auth takes 5 business days. In cancer, 5 days is the difference between stage 3 and stage 4. Between operable and terminal. Between hope and hospice.
42% of the time, it takes longer than 5 days.
I survived brain cancer at 21. My prior auth took 3 weeks. By the time they approved radiation, the tumor had grown. That's not healthcare. That's Russian roulette with paperwork.
Prior authorization isn't medical review anymore. It's weaponized delay wearing a lab coat.
Every denial is calculated. Every appeal deadline designed to outlast the patient. Dead patients don't appeal.
Are you new here? My condolences and my thanks. Follow along and stay loud with the rest of us. More voices means more pressure on a system that counts on silence
SOURCE ➡️ https://www.hematologyadvisor.com/news/nearly-three-in-four-with-cancer-experience-prior-authorizations/