![]() The legislation includes time limits that require insurance companies to act faster. Now, North Carolina lawmakers – along with those in about two dozen other states – are considering changes to overhaul that process. ![]() It’s called “prior authorization” or “utilization review.” Kathleen’s case is extreme, but it underscores why many patients and doctors are frustrated with the process insurance companies use to decide whether to pay for specific treatments. “It is just wrong.” Law would create new rules for insurers “They deny and delay and hope you go away. “I’m convinced that the delay caused her death,” Val told The Charlotte Ledger/N.C. Kathleen underwent the amputation and had several rounds of chemo. Then they said something that was almost more devastating, Val said: that if Kathleen had come in even a month earlier, they probably could have treated the cancer using only chemotherapy. The doctors said they needed to amputate her leg, hip and pelvis. Kathleen went to Memorial Sloan Kettering Cancer Center in New York for treatment. When Kathleen finally had the MRI in March 2019, it revealed an aggressive type of bone cancer. Four weeks later, 41 days after the doctor first sought an MRI, the insurer reversed its decision. “They didn’t bother to review their own records,” Val said. City Police Department – even covered it. The insurance – which came from her husband’s former employer, the N.Y. It ordered her to try six weeks of physical therapy first. After considering the request for two weeks, the insurer said the procedure wasn’t “medically necessary,” her husband said. Her doctor ordered an MRI to find out what was going on, according to court documents and Kathleen’s husband, Val Valentini.īut Kathleen’s health insurer wouldn’t authorize the MRI, a scan that can cost as much as $8,000. The Waxhaw mom tried physical therapy, but her pain just got worse. Kathleen Valentini was 47 when she first noticed a nagging pain in her hip. Lessons from Abroad: How Europeans have tackled opioid addiction and what the U.S.Storm stories – NC Health News works with teens from SE North Carolina to tell their hurricane experiences.Unequal Treatment: Mental health parity in North Carolina.Youth climate stories: Outer Banks edition.When kids’ cries for help become crimes.COVID-19 updates: What’s happening in North Carolina?.
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