Sally Nix was furious when her health insurance company refused to pay for the infusions she needs to ease her chronic pain and fatigue.
Nix has struggled with a combination of autoimmune diseases since 2011. Brain and spinal surgeries didn鈥檛 ease her symptoms. Nothing worked, she said, until she started late last year. Commonly called IVIG, the treatment bolsters her compromised immune system with healthy antibodies from other people鈥檚 blood plasma.
鈥淚VIG turned out to be my great hope,鈥 she said.
That鈥檚 why, when Nix鈥檚 health insurer started denying payment for the treatment, she turned to Facebook and Instagram to vent her outrage.
鈥淚 was raising Cain about it,鈥 said Nix, 53, of Statesville, North Carolina, who said she was forced to pause treatment because she couldn鈥檛 afford to pay more than $13,000 out of pocket every four weeks. 鈥淭here are times when you simply must call out wrongdoings,鈥 she wrote on Instagram. 鈥淭his is one of those times.鈥
Prior authorization is a common cost-cutting tool used by health insurers that requires patients and doctors to secure approval before moving forward with many tests, procedures, and prescription medications. Insurers say the process helps them control costs by preventing medically unnecessary care. But patients say the often time-consuming and frustrating rules create hurdles that delay or deny access to the treatments they need. In some cases, delays and denials equal death, .
That鈥檚 why desperate patients like Nix 鈥 and even some physicians 鈥 say they have turned to publicly shaming insurance companies on social media to get tests, drugs, and treatments approved.
鈥淯nfortunately, this has become a routine practice for us to resort to if we don’t get any headway,鈥 said Shehzad Saeed, a pediatric gastroenterologist at Dayton鈥檚 Children鈥檚 Hospital in Ohio. In March, he , blaming Anthem for denying the biologic treatment his patient needed to ease her Crohn鈥檚 disease symptoms.
In July, Eunice Stallman, a psychiatrist based in Idaho, joined X, formerly known as Twitter, for the first time to , Zoey, had been denied prior authorization for a $225 pill she needs to take twice a day to shrink a large brain tumor. 鈥淭his should not be how it鈥檚 done,鈥 Stallman said.
The federal government has proposed ways to reform prior authorization that would require insurance companies to provide more transparency about denials and to speed up their response times. If finalized, those federal changes would be implemented in 2026. But even then, the rules would apply only to some categories of health insurance, including Medicare, Medicare Advantage, and Medicaid plans, but not employer-sponsored health plans. That means roughly wouldn鈥檛 benefit from the changes.
The 2010 Patient Protection and Affordable Care Act prohibits health insurance plans from denying or canceling coverage to patients due to their preexisting conditions. AHIP, an industry trade group formerly called America鈥檚 Health Insurance Plans, did not respond to a request for comment.
But some patient advocates and health policy experts question whether insurers are using prior authorization as 鈥渁 possible loophole鈥 to this prohibition, as a way of denying care to patients with the highest health care costs, explained Kaye Pestaina, a 素人色情片vice president and the co-director of its Program on Patient and Consumer Protections.
鈥淭hey take in premiums and don鈥檛 pay claims. That鈥檚 how they make money,鈥 said Linda Peeno, a health care consultant and retired Kentucky physician who was employed as a medical reviewer by Humana in the 1980s and . 鈥淭hey just delay and delay and delay until you die. And you鈥檙e absolutely helpless as a patient.鈥
But there鈥檚 reason to hope things may get marginally better. Some major insurers are to ease preapproval mandates for doctors and patients. And to rein in the use of prior authorization.
鈥淣obody is saying we should get rid of it entirely,鈥 said Todd Askew, senior vice president for advocacy at the American Medical Association, in advance of the group鈥檚 . 鈥淏ut it needs to be right-sized, it needs to be simplified, it needs to be less friction between the patient and accessing their benefits.鈥
Customers are increasingly using social media to air their complaints across all industries, and companies are paying attention. Nearly two-thirds of complainants reported receiving some sort of response to their online post, according to the 2023 鈥淣ational Consumer Rage Survey,鈥 conducted by Customer Care Measurement & Consulting in collaboration with Arizona State University.
companies are better off engaging with unhappy customers offline, rather than responding to public social media posts. But many patients and doctors believe venting online is an effective strategy, though it remains unclear how often this tactic works in reversing prior authorization denials.
鈥淚t鈥檚 not even a joke. The fact that that鈥檚 how we鈥檙e trying to get these medications is just sad,鈥 said Brad Constant, an inflammatory bowel disease specialist who has published research on prior authorization. that prior authorizations are associated with an increased likelihood that children with inflammatory bowel disease will be hospitalized.
Saeed said the day after he posted the picture of the skin rash, the case was marked for a peer-to-peer review, meaning the prior authorization denial would get a closer look by someone at the insurance company with a medical background. Eventually, the biologic medicine Saeed鈥檚 patient needed was approved.
Stallman, who is insured through her employer, said she and her husband were prepared to pay out of pocket if Blue Cross of Idaho didn鈥檛 reverse the denial for the drug Zoey needed.
Bret Rumbeck, a spokesperson for the insurer, said Zoey鈥檚 medication was approved on July 14 after the company consulted an outside specialist and obtained more information from Zoey鈥檚 doctor.
Stallman posted details about the ordeal online only after the insurer approved the drug, in part, she said, to prevent them from denying the treatment again when it comes up for a 90-day insurance review in October. 鈥淭he power of the social media has been huge,鈥 she said.
Nix had been insured by Blue Cross Blue Shield of Illinois through her husband鈥檚 employer for almost two decades. Dave Van de Walle, a spokesperson for the company, did not specifically address Nix鈥檚 case. But in a prepared statement, the company said it provides administrative services for many large employers who design and fund their own health insurance plans.
Nix said an 鈥渆scalation specialist鈥 from the insurance company reached out after she posted her complaints on social media, but the specialist couldn鈥檛 help.
Then, in July, after 素人色情片Health News contacted Blue Cross Blue Shield of Illinois, Nix logged in to the insurer鈥檚 online portal and found that $36,000 of her outstanding claims had been marked 鈥減aid.鈥 No one from the company had contacted her to explain why or what had changed. She also said she was informed by her hospital that the insurer will no longer require her to obtain prior authorization before her infusions, which she restarted in late July.
鈥淚鈥檓 thrilled,鈥 she said. But 鈥渋t just should never have happened this way.鈥
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