By Raghav Mathur, Co-Founder of No Surprise Bill
This week, I want to share a story that hits painfully close to home—a reminder of why we started No Surprise Bill and why the fight for patient-centered care is more urgent than ever.
My daughter has a rare condition that requires a high-cost medication to keep her healthy. Last year, her doctor prescribed a new medication—a treatment that offered hope for better days ahead. But what should have been a straightforward process turned into a six-month battle.
The Insurance Delay Game: Cigna’s Denials
For half a year, Cigna denied our prior authorization requests. Despite mountains of paperwork from our doctor and hours spent pleading our case, the denials kept coming. Each rejection wasn’t just a blow to our spirits; it was a direct hit to my daughter’s health. Finally, in late January, after relentless appeals and phone calls, Cigna approved the authorization. But our relief was short-lived.
The Specialty Pharmacy Obstacle: Accredo’s Delay Tactics
Just when we thought the hardest part was over, we encountered another hurdle: Accredo, the specialty pharmacy responsible for delivering the medication. What makes this even more infuriating? Accredo is owned by Cigna. When Accredo delays care, Cigna financially benefits by holding onto funds longer and avoiding timely payouts.
For nearly a month, my wife and I have spent countless hours on the phone with Cigna, Accredo, and our doctor’s office. Despite our efforts, we still don’t have a confirmed delivery date. As I write this, my daughter has been without her necessary medication for over two weeks, as her prescription for her previous, less effective, medication ran out.
A System Rigged for Profit, Not Patients
Our experience is not unique. Across the country, patients and families are caught in an endless loop of delays and denials designed to maximize profits for insurers and specialty pharmacies. These companies are playing a dangerous game with people’s lives, using prior authorizations and delivery delays as tools to cut costs and boost earnings.
Recent studies confirm that these tactics are widespread:
- Prior Authorization Delays: The American Medical Association has documented the harmful effects of delayed authorizations, with patients often suffering serious health setbacks as a result.
- Specialty Pharmacy Bottlenecks: Surveys show that missing patient information and administrative inefficiencies are major contributors to delays, leaving patients without the medications they desperately need.
A Call for Accountability
Legislative efforts are gaining momentum, like California’s Senate Bill 363, which would impose million-dollar fines on insurers that repeatedly deny necessary care. But until meaningful reforms are enacted, families like mine will continue to suffer.
Why No Surprise Bill Exists
At No Surprise Bill, we’re fighting to hold insurers accountable. My personal story is just one example of why this fight matters. No family should have to battle bureaucracy to access medical care.
We’re here to advocate for you, to challenge the system, and to ensure that no patient is left behind in the name of corporate profit. Together, we can push for real change.
Until next time, Raghav Mathur
