In summary
Many Californians who need urgent health services are often delayed due to an insurance protocol known as prior authorization. A bill in the Legislature could reform prior authorization rules so that it no longer serves as a barrier to essential treatment.
Guest comment written by
Ocean McIntyre
Ocean McIntyre is a space science communicator in the Los Angeles area.
In 2008, I started losing my vision rapidly due to a condition called idiopathic intracranial hypertension. Eventually I lost my independence, my ability to work, and ultimately my life as I knew it.
But it wasn’t just the condition itself that caused me to lose my sight. It was also the countless delays in obtaining treatment that I encountered, thanks to the so-called prior authorization. Prior authorization is the process required by health insurance companies before approving medical services prescribed by health care providers.
For many patients, they are simply delay tactics. In my case, these delays kept me away from the care I needed as my brain essentially pinched my optic nerves.
I continue to live with the effects of pre-authorization. If I had been allowed to get the care I needed when I needed it most, I would still be able to drive a car, fly an airplane, look through a telescope, see color, or walk without a cane.
But I can not. I can never do those things again.
This disrupted process could be resolved if the legislature passes Sen. Nancy Skinners’ proposal, Senate Bill 598. The bill would grant a one-year prior authorization waiver to physicians who practice under a health plan for at least 90% of the time.
My pre-authorization trials began as soon as I received my diagnosis. My doctor requested urgent clearance to see a neuro-ophthalmologist, but clearance was denied. He put another one, and it was denied again. Then again.
I spent so much time calling to find out why the clearances hadn’t been approved that I developed a relationship with my medical group’s nurse case manager, who was equally frustrated by the denials. I can’t tell you how many times we’ve sat on the phone and cried together.
Learn more about the lawmakers mentioned in this story
State Senate, District 9 (Oakland)
State Senate, District 9 (Oakland)
Time in the office
2016present
Background
University educator
I haven’t gotten approval for that rush clearance for more than 12 weeks. During that time, there was nothing I could do. I couldn’t pay out of pocket because of the rules that existed. I was stuck.
When I finally saw a neuro-ophthalmologist, I could barely see. He told me I had to have surgery and that my best hope was to never lose my sight again. It still took two weeks to get authorization for that surgery, despite all of his prodding.
I had brain surgery later that year and the neurosurgeon told me he didn’t think I would ever be able to have a normal, independent life again based on how my brain looked.
My recovery was long and excruciating, made worse by the length of time I had to wait for treatment. The hardest part was that my 7 year old lived it with me. I have become a shell of the person I used to be.
We were homeless for a time when I could no longer work.
It took 10 years, but I was finally able to find a full time job again. Now I have my dream job, working on a major space mission.
But it hasn’t been an easy road and I still have my issues stemming from my delayed treatment. Just last year I had to have the shunt replaced again in my brain.
My experience is also not unique. There are countless others who have gone through similar and worse experiences with prior permission. The fact that treatment was so often denied made me feel like I didn’t matter that my life didn’t matter.
It shouldn’t be like that. I hope we can pass SB 598 and reform prior authorization. Health insurance should be there when you need it most.
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