The Medical Limbo Of ‘Prior Authorization’

Your doctor says you need this treatment. But your insurance company says they don’t agree. Your pharmacist receives your prescription, but won’t fill it until your insurance provider greenlights it. This back-and-forth is called “prior authorization” and it’s how your health insurance company determines what medicines they will or will not cover. It also creates lengthy wait times for patients who need the medicine immediately – if they’re able to get it at all. Illinois Gov. JB Pritzker recently announced he’ll introduce a bill to stop what he called “predatory insurance practices.” Reset learns more about how this impacts patients and health care providers from UChicago Harris School of Public Policy assistant professor Zarek Brot-Goldberg and Reset listener Jackie Covarrubias, who says her father’s chemotherapy medication often gets denied by his insurance. For a full archive of Reset interviews, head over to wbez.org/reset.