Consumer Fights to Reform Prior Authorization Process 

By Consumers for Quality Care, on January 31, 2024

Consumer Fights to Reform Prior Authorization Process 

Last August, KFF Health News chronicled the story of Sally Nix, whose health insurance company refused to pay for the infusions she needed to treat her autoimmune disease. Nix then started a social media campaign to shame her insurer into reconsidering its decision. The campaign succeeded initially, getting her prior authorization requirements waived for past and future treatment. But the day after KFF published the story of Nix’s success, her insurance company backtracked, informing Nix that her condition did not qualify for these infusions after all.  

Prior authorization is a health insurance cost-control measure that often causes delays, making it difficult for patients to access necessary treatments. Patient advocates suspect some insurers are exploiting prior authorization to deny care, which hurts patients’ health outcomes.  

Nix is now seeking to reform the prior authorization process. She started a campaign that has garnered nearly 22,000 signatures. The campaign calls on her insurer, Blue Cross Blue Shield of Illinois (BCBSIL), to reevaluate its decision not to cover her infusions. She has also filed complaints against BCBSIL with the U.S. Department of Health and Human Services, U.S. Department of Labor, Illinois Department of Insurance, and the Illinois Attorney General.  

It is reprehensible what they’re doing. But they’re not only doing it to me. “They’re doing it to other patients. And it’s got to stop,” said Nix.  

CQC urges health insurers to eliminate burdensome procedural hurdles that prevent consumers from receiving the medical care they need.