We turned to Reddit to hear directly from healthcare workers about their experiences with appealing insurance denials. You can read the whole thread for yourself, but we've summarized the main takeaways below.
The most striking finding? Nearly every healthcare provider reports appealing prior authorization denials, with many citing success rates of 85-90%. As one psychiatrist put it, "100% of the time. I don't prescribe anything adventurous without good reason. If I've gone for it, I think there's reason for it and the patient will be worse off by giving in."
Multiple providers reported that many denials appear to be automatic or "batched" without proper review. One notable example: Cigna was recently investigated for allegedly auto-denying 300,000 claims without proper review. As one provider noted, "They're probably using 'AI' to deny it, which is probably just a random number generator that denies 70% of things outright."
Particularly concerning were stories about denials for cancer treatment. As one provider explained, "Chemotherapy also has been advancing rapidly. Now there are problems when new consensus guidelines suggest neoadjuvant chemo rather than resection... Insurance denies. Now you can wait and fight or bow to less optimal but more accessible therapy that isn't even necessarily cheaper."
Healthcare providers consistently reported spending significant time on appeals:
Several providers mentioned developing systems to improve their approval rates:
Many providers mentioned outsourcing the appeals process:
The discussion reveals a healthcare system struggling with administrative burden, but also shows providers developing innovative solutions. Many are calling for systemic changes:
While the current prior authorization system creates significant challenges, healthcare providers are finding ways to navigate it successfully. The key seems to be persistent advocacy combined with efficient systems for managing the appeals process. As one provider summed it up: "If I thought I could remove a year from an insurance company's executive's life on a per appeal basis, I'd probably appeal 100% of them."