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Who Really Pays the Price with Prior Authorization?

Daniel Paull MD tells of how prior authorization caused a patient to lose her leg.

December 21, 2023

Let’s say that you’re having a lot of hip pain.

It bothers you during the day, but it really hurts at night.

It also has felt like you’ve been sick for the past six months, as you’ve had a general malaise.

“I must be eating less”. This helps explain the 20 pounds you lost over the past few months without trying.

 

Since your hip bothers you, and it isn’t getting any better, your PCP refers you to some physical therapy, and it doesn’t work.

Eventually you get referred to an orthopedic surgeon, who seems somewhat alarmed.

They want an MRI immediately.

This scares you.

 

 

Nervously waiting your MRI, you find out that that your health insurance company denies it, saying that they want you to do physical therapy first, which you already did.

Your doctor has to appeal the MRI, and 41 days later, you finally get it approved.

 

To your horror, the MRI reveals an aggressive bone tumor, and you will need to get half of your pelvis and the rest of your leg amputated.

 

To your horror, the MRI reveals an aggressive bone tumor, and you will need to get half of your pelvis and the rest of your leg amputated. Read a true story of prior auth denial. Click To Tweet

 

The doctors say that if you had come in a month earlier then they could have probably just done chemo.

Unfortunately for you and your family, the cancer continues to spread, and this is how you die.

 

Health insurers routinely deny necessary care and have absolutely no legal liability.

A cash pay MRI can cost $500, which is sometimes less than those with a high deductible will pay.

Health insurance is a huge scam with real life sometimes dire consequences.

The above story is a real story.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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