Senate Bill 250 would allow patients to get treatments they urgently need without delays from insurance companies by requiring insurers to consult with doctors when determining which services require authorizations.
By Vivian Gonzales, Special to CalMatters
Vivian Gonzales is a public health nurse living in Los Angeles.
When doctors identified a tumor growing in my dad’s lungs last August, we knew that any chance we had of beating his cancer would be rooted in the team of specialists handling his care and taking swift action. Curing my father’s cancer, however, was completely at odds with the goals of his health insurer.
From the start, virtually every treatment and test his doctors said he needed required prior authorization. Prior authorization requires doctors to get approval from a health insurance company before prescribing medicines or performing medical services.
State Sen. Richard Pan, an M.D., has a bill pending in the California Legislature that will change this broken system. Senate Bill 250 will allow patients like my dad to get treatments they urgently need without unnecessary delays from insurance companies by requiring insurers to consult with doctors when determining which services require authorizations and streamlining the process to allow physicians to provide treatments and services based on their patients’ needs.
Before my dad’s treatment could even begin, his doctors struggled to get approval for a biopsy that would detect early signs of cancer and provide a more accurate diagnosis.
Ten weeks later, diagnostic testing showed that my dad had metastatic melanoma. He was referred to an oncology specialist, where again there was a delay in obtaining approval for further diagnostic testing — a positron emission tomography (PET) scan. Four weeks later, the scan showed his cancer had already spread into his adrenal gland, hips and lungs.
His team of doctors kept our spirits high and developed an immunotherapy treatment plan.
In January, I was thrilled to get dad transferred to the University of Southern California’s state-of-the-art Keck Hospital, offering specialty care and trials for metastatic melanoma. Every new treatment or scan, however, was met with an obstacle course of prior-authorization denials, appeals and ultimate approvals from my dad’s insurer.
I worked hand in hand with his team of specialists, who kept his insurance company on speed dial. I vividly remember spending three and a half hours one day in March trying to request appeals of its denial of an MRI and PET scan requested by his doctors.
Time is your most precious resource when it comes to cancer, and I was spending my time — the last few months of my father’s life — fighting with his insurance company.
Still, we held out hope as his doctors worked to get him into a clinical trial that would ensure he got immediate treatment, rather than the repeated delays from the prior-authorization process. But in early April, an MRI showed that his cancer had spread to his brain and he would no longer qualify for the clinical trial.
Dad’s doctor told us not to give up. We didn’t. But he was then referred to a radiation oncologist to continue with a different form of treatment — radiation therapy. The referral was denied. Appealed. Overturned. It was all too late. Dad passed away on April 27, 2022.
I wish Senate Bill 250 had been in place in time to help my father.