"I was fighting to survive": Patients still struggle with preauthorization despite promise of reform

March 11, 2026

TL;DR

Sheldon Ekirch battled Anthem for two years to cover $10,000-per-infusion blood plasma treatments for small-fiber neuropathy, facing repeated denials until an external review overturned the decision.
Millions of patients annually encounter denials through prior authorization, a process requiring pre-approval from insurers before medical care.
Despite a 2023 pledge by insurance leaders to simplify prior authorization by reducing scope and improving turnaround times, many insurers have failed to provide specifics on changes made.
Patient advocates express pessimism, stating insurers prioritize profits over patient well-being and that fiduciary responsibility lies with shareholders, not patients.
Recent patient experiences, including Payton Herres' struggle with a heart transplant medication and Anna Hocum's fight for treatment for a rare genetic condition, highlight the ongoing burdens and anxieties caused by prior authorization.
Some insurers, like Aetna CVS Health, Humana, and UnitedHealthcare, have reported specific changes such as bundling authorizations or removing requirements for certain diagnostic services, though the overall impact is debated.
The American Medical Association notes that prior authorization remains costly, inefficient, opaque, and hazardous for patients, despite previous reform efforts.

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