New York Times personal finance columnist Ron Lieber received an unwelcome letter from his family’s insurance plan less than 36 hours before his wife’s scheduled major surgery: it was denying prior authorization for the procedure. With no time to lodge an appeal, Lieber and his wife decided to proceed and bet on her doctors’ ability to reverse the decision post-surgery. They succeeded, but the experience troubled him.
Lieber’s wife, Jodi Kantor, was diagnosed with breast cancer in 2024 and was scheduled for surgery at Memorial Sloan Kettering on a Monday morning in December. The insurance denial was puzzling because United Healthcare wasn’t even denying the reconstructive part of the surgery—the part a plastic surgeon does. They were denying the mastectomy itself. The billing office at the hospital quickly assured him they’d known about the denial for seven or eight days and would have called immediately if they thought there would be a problem.
This experience prompted Lieber to investigate why patients weren’t getting advance notice of insurance problems. He eventually published a column detailing his family’s story and received more than 500 reader comments, many from people who had experienced far worse scenarios. Some readers reported being sent home the morning of surgery because insurance issues couldn’t be resolved. One person had anesthesia already in her arm before the needle was yanked out and she was sent away to try again another day.
In his follow-up work, Lieber created a template for a note doctors could use to inform patients about prior authorization before surgery. The template addressed how insurance companies might deny payment, explained that patients shouldn’t worry, and provided contact information for the billing department. He refined the template based on feedback from physicians and patients, eventually simplifying the language to a fifth-grade reading level after receiving criticism that his initial version was too complex.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://kffhealthnews.org/news/podcast/insurance-denial-prior-authorization-personal-finance-guru-crowdsourced-tips/