In Their Own Words

This Doctor Spends Hours Talking to Insurers. Her Patients Suffer The Most.

Prior Authorizations Were Meant to Cut Costs. Now They Delay Care, Says CHOP Rheumatologist

February 28, 2024

By:

Dori Abel, MD

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The following excerpt is from an op-ed that first appeared in the Philadelphia Inquirer on February 28th, 2024.

My patient — we’ll call her Sydney — was a young teenager who had been sick for weeks. We ultimately diagnosed her with an aggressive, rare disorder of the blood vessels that can restrict blood flow and damage vital organs.

Sydney received Remicade, a targeted, immunosuppressive medication known as a biologic during her hospitalization, and it worked. Her fevers abated, her energy returned, and her labs showed dramatic improvement. Yet, despite Sydney’s visible improvement during her hospital stay, her insurance provider denied payment for her Remicade treatments when she went home.

After an initial letter explaining the necessity of her medication, followed by a 75-minute phone call with Sydney’s insurance company three weeks later, we ultimately got her medication approved, four weeks after we prescribed it. Fortunately, Sydney was only one day late for her monthly dose.

Unfortunately, I have many other patients whose struggles with insurance over medication coverage haven’t ended so well.

As a pediatric rheumatologist, I care for children with rare forms of chronic illness for which we now have highly effective therapies. But too often, my patients can’t access these effective therapies because insurers put up many barriers to coverage.

Read the entire op-ed here.