SB 516, authored by Senator Nancy Skinner and sponsored by the California Medical Association (CMA) will reform the prior authorization process in California to ensure patients get the treatment they need when they need it. 

The New York Times published an opinion video today, titled "What’s my life worth? The Big Business of Denying Medical Care" that clearly demonstrates how insurance companies use prior authorization to protect profits, putting patients at risk.

To produce the video, the New York Times interviewed more than 50 physicians and patients who have dealt with prior authorization delays firsthand, including Irvine-based pediatrician and CMA member, Eric Ball, M.D., who spoke about how the “peer-to-peer" process for appealing a prior authorization denial can involve speaking with a physician who does not have a relevant specialty.

“I’m a pediatrician and sometimes I’ll end up talking to a neurologist,” Dr. Ball said. “Often times it’s not even a physician.”

Also interviewed were California patients Vivian Gonzales and Ocean McIntryre, both of whom were harmed by prior authorization delays and had courageously shared their stories with the California Legislature last summer when prior authorization legislation was heard in the Assembly Health Committee.

Gonzales, a public health nurse, dealt with multiple denials while trying to obtain care for her father, whom she eventually lost to cancer. “I spent so much time on the phone, writing letters, faxing, that I didn’t get to spend that time with my father,” Gonzales said in the video.

And McIntyre, a space science communicator, lost her eyesight as the care she needed was delayed for months due to prior authorization. “I finally got the authorization to see the neuro-ophthalmologist after 12 weeks, and he said, ‘We’re going to do this surgery, but it’s only to preserve the vision you have left. If we had seen you earlier, that would have been a different story,’” McIntyre said in the video. “Maybe I’d be able to see now. Maybe I’d have a different life.”

This year, CMA is sponsoring SB 516 to reform the prior authorization system and ensure patients get treatments they urgently need without unnecessary delays. Over the course of this legislative session, be on the lookout for updates and further communications regarding SB 516.

Share Your Story

CMA physicians have staunchly advocated for prior authorization reform by sharing personal stories and stories from patients about harmful care delays and denials; speaking to local media about the need for prior authorization reform; and submitting video testimonies about the impact of prior authorization. Patient witnesses also shared harrowing testimony in legislative hearings and through media outlets about the devastating impacts prior authorization delays have had on their lives and their loved ones.

CMA urges physicians to continue to share stories about the harms of prior authorization delays – both from your own experiences and practices, as well as from your patients. Together, we can win this fight and create a better system that prioritizes patients over profits.