Opinion | I’m a doctor. My decisions are overruled by health insurance denials.

Elisabeth Rosenthal’s May 18 Thursday Opinion essay, “Denials of health-insurance claims are rising — and getting weirder,” hit the nail on the head. As a rheumatologist, I see many patients who struggle to keep up with their daily activities and depend on access to necessary treatments to manage their chronic pain. Insurers’ prior-authorization policies amplify my patients’ struggle by building ineffective hurdles and delaying access to medications I know are best for my patients. More than 54 million Americans live with a rheumatic disease, and delays in their care can mean irreversible disease progression and permanent loss of bodily functions.

Prior authorization, the process by which health insurers require doctors to request coverage approval for medically necessary care, has gotten out of hand. I’ve seen the volume of requests grow exponentially, forcing many practices, including mine, to dedicate enormous resources to hire staff specifically dedicated to dealing with this enormous administrative burden. Often, these requests are delayed and denied by representatives who don’t work in the same specialty, meaning my years of medical education, training and relationship-building with patients are often arbitrarily overruled.

I’m thankful the current administration has taken the first step to propose rules that would limit the use of prior authorization, making the process more transparent and efficient. But more must be done. I urge policymakers and Congress to implement solutions to stop insurers from overtaking the medical decision-making process and protect long-term patient health.

The writer is a member of the American College of Rheumatology.

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