Sheldon Ekirch, diagnosed with small fiber neuropathy, struggles with chronic pain and insurance coverage issues. Despite managing her condition with over a dozen prescriptions, her health insurer has repeatedly denied coverage for a potentially effective treatment called IVIG, which could significantly alleviate her suffering. This case exemplifies the critical frustrations that many face with prior authorization processes in healthcare, which are intended to control costs but often leave patients feeling neglected and hopeless in their pursuit of necessary care.
"I'm paying a lot of money for health insurance, said Ekirch, who pays more than $600 a month in premiums. I don't understand why they won't help me, why my life means so little to them."
"For 50 years, insurers have employed prior authorization, they say, to reduce wasteful health care spending, prevent unnecessary treatment, and guard against potential harm."
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