As if the insurance industry needed another reminder that it’s universally adored, the titans of health coverage are slinking back from their beloved pastime of delaying or outright denying medical care. Facing the usual suspects—regulators, fed-up patients, and doctors who apparently still have a conscience—the insurance behemoths have decided, with a heavy heart, to ease off on the bureaucratic gymnastics known as prior authorization.
For the uninitiated, prior authorization is the charming practice where patients often discover at the eleventh hour whether their life-saving surgery or prescription is covered. Picture it: you’re prepped for surgery, only to learn your insurer’s magic eight-ball says, “Ask again later.” The process is as clear as mud, with patients receiving cryptic form letters that make Kafka’s work look like children’s literature. Meanwhile, people either delay essential treatments or abandon them altogether because they’ve been left to decipher the insurance industry’s hieroglyphs.
Surprise, surprise: lawmakers, regulators, and the general public are starting to notice that letting people suffer or die doesn’t play well in PR campaigns. Lawsuits are piling up, some even pointing fingers at insurers for patient deaths. The untimely demise of a UnitedHealthcare executive last December has only added fuel to the fire, with social media doing what it does best—rallying outrage and demanding change.
David A. Lipschutz, a voice of reason in a sea of jargon, points out that prior authorization is the insurance industry’s go-to method for cost control. Studies suggest that insurers have a penchant for denying care, especially in private Medicare plans. But don’t worry—most appeals are successful! Of course, this assumes patients are informed enough to appeal and have the stamina to navigate the labyrinthine process. A rousing success story, indeed.
So here we are, witnessing insurers promising to behave better, as if their New Year’s resolution is to be less villainous. Yet one can’t help but wonder: is this a genuine shift in ethos, or just another PR stunt to placate the masses? History suggests the latter. After all, why should insurers stop a practice that has effectively padded their bottom line, unless the threat of regulation becomes too real to ignore?
