Kathleen Valentini was every doctor’s dream patient: she got regular check-ups and followed their advice. But when her orthopedist wanted her to get an MRI for the pain in her leg, Kathleen’s insurance company stepped between them and said the MRI “wasn’t medically necessary.” The doctor appealed the denial, but the insurance company’s “prior authorization” bureaucracy resulted in a delay in treating the fast-growing cancer. Kathleen’s leg, hip, and pelvis were amputated. We sued the insurance company for negligence, but lost in the trial court because the judge said while tragic, there is no law holding insurance companies accountable when they commit medical malpractice.
Prior authorization—when you need your insurer’s permission to get medical care—is a major part of health insurers’ scheme to rake in profits by denying and delaying patients’ care. The “Deny. Delay. Defend” strategy used by health insurance companies is believed to be a major reason that Kathleen Valentini lost her leg, and ultimately, her life. According to Pollock Cohen partner Steve Cohen, “Whether rampant waste and fraud is minimized with this additional step between patient and doctor is still in question.”
We have been leading the fight to draw attention to this injustice. Hear Steve speak about prior authorization below.