1. United States
2. Calif.
3. Letter

Requesting Senate HELP Committee oversight hearing on prior authorization and insurance denials practices: It has come to light that some health insurance companies are pressuring medical directors to review requests for patient coverage and make denial decisions too hastily, including having doctors outside of the relevant medical specialty review complex cases. This troubling practice prioritizes speed over thorough reviews, potentially leading to wrongful denials that endanger patients' health. Medical directors report intense productivity monitoring, unreasonable time constraints, and quota-like targets that incentivize fast approvals or denials rather than diligent case evaluation based on medical evidence. One former medical director from Cigna alleges the company allotted as little as 2-5 minutes to review drug requests and 4 minutes for prior authorizations of major procedures. Medical directors unable to keep up this frenetic pace faced disciplinary action or termination. Such an assembly-line approach to medical decision-making is unconscionable and likely violations patient protections outlined in laws like the Affordable Care Act. Incidents of egregious errors further underscore the human costs of these practices – nurses mislabeling patients, confusing body parts and conditions, and putting vulnerable patients at risk of being denied vital care by doctors practicing outside their area of expertise. All this points to a system prizing profits and speed over patient wellbeing. The Senate HELP Committee must use its oversight authority to investigate prior authorization and medical necessity denial practices across the health insurance industry. American patients deserve assurance that life-or-death treatment decisions are being made methodically by qualified professionals in the appropriate medical specialty, not rushed through callous corporate algorithms. Shining a light on these abuses is essential to restore integrity to our healthcare system.