When Matt Conway tore his bicep delivering a table recently, there were numerous barriers to getting it fixed.<\/p>\n
First, \u201ca month of navigating structural insurance blockades,\u201d then just 15 minutes for the orthopedic surgeon to order an MRI \u201cSTAT\u201d to proceed to surgery. But Conway couldn\u2019t schedule the MRI that day because prior authorization was required by the insurance company.<\/p>\n
He persisted in what many patients would not: \u201c37 hours of relentless phone calls just to get my insurance company to approve my surgeon\u2019s urgent \u201cSTAT\u201d order.\u201d<\/p>\n
Finally, he got the MRI but the delay pushed the test into the late hours of Friday, meaning the results couldn\u2019t be read until days later.<\/p>\n
\u201cA 37-hour insurance delay easily turns into a 4-day medical delay. When you are facing a closing window for surgery, every single hour counts,\u201d Conway, a former health care strategist who now runs The RiseUP Group Inc. in Hartford, said in a post chronicling the ordeal.<\/p>\n
While he waited, his bicep retracted, making the surgery more complicated and risky, Conway said.<\/p>\n
\u201cDoctors should be allowed to practice medicine, and patients shouldn\u2019t have to fight a bureaucracy just to follow their surgeon\u2019s urgent orders,\u201d he said.<\/p>\n
He formed the CT Patient & Provider Protection Coalition to challenge \u201cdelay and deny insurance tactics\u201d he said are harming patients and burning out physicians.<\/p>\n
Local doctors, lawmakers, patients and the American Medical Association, say that the number of prior authorizations and claim denials that insurance companies issue is increasing, leading to delays in care and countless hours of doctors\u2019 time lost in advocating for their patients to receive the tests, prescriptions or procedures they prescribed.<\/p>\n
\u2018Automatic denials that are roadblocks for patients to access care\u2019<\/p>\n
Sen. Matt Lesser, a Middletown Democrat, who also serves on the state\u2019s Insurance and Real Estate Committee, said he hears almost every day from people in the community who have had health insurance claims denied including denial of specific treatments for cancer, procedures and hysterectomies.<\/p>\n
\u201cWhat we are hearing is that there\u2019s an increasing use of technology to automate the process including the use of AI \u2014 automatic denials that are roadblocks for patients to access care.\u201d<\/p>\n
Sen. Saud Anwar, co-chair of the state\u2019s Public Health Committee, said it \u201cis absolutely outrageous what the insurance companies are doing to the patients.<\/p>\n
\u201cBetween prior authorizations for the most basic medications, critical tests and procedures, they are creating hoops and difficulties and frankly they are abusing their position and some of the federal laws that have given them protection,\u201d he said. \u201cThey\u2019re using that in a manner which is now hurting the citizens of the state of Connecticut and basically killing the field of medicine altogether because people learn medicine to provide care, not to be on the phone holding to talk to somebody who\u2019s not even qualified to have the conversation on the medical wellbeing of the patient.\u201d<\/p>\n
Lesser said sometimes it is not even a real denial but an automated one that can be appealed.<\/p>\n
\u201cBut meanwhile people are freaking out,\u201d he said. \u201cThey have been told that they can\u2019t get this essential procedure that they have been told that they need and so of course their alarm is sky high and then there are other people who can\u2019t get the treatment because it is a real denial.\u201d<\/p>\n
In the midst of claim denials and prior authorizations, the health industry is also contending with an increase in hospital and pharmaceutical costs.<\/p>\n
The Connecticut Insurance Department Report Card on health insurance carriers in the state reports that the insurance companies saved\u00a0 $187 million by requiring prior authorizations in 2024. The report further says that 13% of Cigna\u2019s benefits require prior authorization compared to 32% for ConnectiCare, 38% for United HealthCare and 4% for Anthem.<\/p>\n
The Courant sent questions to Connecticut insurance companies Anthem, Cigna, ConnectiCare and United HealthCare, inquiring how many claims each has denied and how many prior authorizations it issued in the last year. None responded to the Courant\u2019s questions concerning its data.<\/p>\n
An Anthem Blue Cross Blue Shield spokesperson did not answer the Courant\u2019s questions but instead asked that questions be directed to Susan Halpin, executive director of the Connecticut Association of Health Plans, who is listed as a lobbyist for the association.<\/p>\n
Halpin said in an email, \u201cConnecticut health plans process millions of claims each year, yet prior authorization applies to only a subset of healthcare services.<\/p>\n
\u201cAccording to the Connecticut Insurance Department\u2019s 2025 Consumer Report Card, which reports 2024 data, the majority of covered healthcare services were delivered without prior authorization review,\u201d she said. \u201cDepending on the carrier and product, between 62% and 97% of covered services were not subject to prior authorization requirements at all.<\/p>\n
Halpin said \u201chealth plans have worked in recent years to further reduce administrative burden by eliminating prior authorization requirements for many routine and lower-risk services, expanding electronic prior authorization capabilities, implementing real-time decision tools, and creating programs that allow qualified providers to receive expedited approvals or exemptions from certain requirements.\u201d<\/p>\n
A spokesperson for the Cigna Group said the insurance group is \u201ctaking steps to reduce the burden prior authorization can create for both patients and physicians.<\/p>\n
\u201cIn 2025, fewer than 6 percent of our customers had prior authorization requirements and we\u2019re taking steps to reduce that number by year-end,\u201d the spokesperson said. \u201cThis year alone, we eliminated these requirements on about 15% of services, tests and procedures. The majority of requests are handled electronically, often in real time, and most are approved within one day.\u201d<\/p>\n
United HealthCare referred the Courant to its website on its claim approval rate and why a prior authorization is needed.<\/p>\n
\u201cAt UnitedHealthcare, we approve and pay 90% of claims shortly after they\u2019re submitted,\u201d the website said. \u201cThe remaining 10% go through an additional review process.\u201d<\/p>\n
\u2018They are making it impossible to practice medicine\u2019
\n![\"Dr](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/06\/hakim-1.jpg\")
Dr Mariam Hakeem-Zargar, left, an orthopedic surgeon in Torrington, an independent doctor working in a small office, said dealing with claim denials and prior authorizations is now taking up 20 to 30% of her staff\u2019s time.
\n(submitted)<\/p>\n
Dr Mariam Hakeem-Zargar, an orthopedic surgeon with a small independent practice in Torrington, said dealing with claim denials and prior authorizations is now taking up 20 to 30% of her staff\u2019s time.<\/p>\n
\u201cTime that they don\u2019t have to answer phone calls for patients, help patients do scheduling,\u201d she said. \u201cThey are just killing us with paperwork. They\u2019re making it impossible to practice medicine. They are not in the business of care.\u201d<\/p>\n
She said Medicare Advantage plans in order to make a profit \u201cjust deny care or make it hard to get care by instituting these prior authorization policies.<\/p>\n
\u201cEvery time we want to prescribe a medication, if it\u2019s in their list of expensive things, that means prior authorization,\u201d she said. \u201cThen you submit a form. Wait for an answer. Denied.\u201d<\/p>\n
Dr. Khuram Ghumman, associate dean for strategic partnerships at the Frank H. Netter MD School of Medicine at Quinnipiac University and a practicing physician, said \u201cunwanted and unintended consequences\u201d of insurance company policies \u201ccan sometimes lead to delayed care and sometimes no care.\u201d<\/p>\n
He said he encounters claim denials often in his practice.<\/p>\n
\u201cI think they value profit over patients,\u201d he said.<\/p>\n
A pledge to fix prior authorizations<\/p>\n
The American Medical Association reported last month that after \u201csuccessful engagement from the Trump administration to address concerns from patients and physicians roughly 60 health insurers pledged to fix prior authorization requirements via efforts through 2027.\u201d<\/p>\n
The AMA surveyed 1,000 physicians to assess their views on the pledge.<\/p>\n
\u201cFindings from the survey show that only one in three physicians (33%) believe the latest insurer pledge will make a meaningful difference,\u201d said the AMA in a release.<\/p>\n
The survey also found that more than 1 in 4 physicians report that prior authorization has led to a serious, adverse event for a patient in their care.<\/p>\n
Dr. Bobby Mukkamala, a board certified head and neck surgeon and past president of the American Medical Association, said across the country, \u201cevery insurance company seems to use prior authorization as a tool in their opinion.<\/p>\n
\u201cBut we see it as a barrier in our opinion,\u201d he told the Courant. \u201cIt\u2019s the vast majority of patients that have this concern that prevents them from getting the right thing or the best thing and instead sometimes relying on second best versus just giving up, and both obviously are bad.\u201d<\/p>\n
He recalled a patient with tonsil cancer who needed a PET scan that took a month to get approved.<\/p>\n
\u201cAnd during that month, sure enough a lymph node in the neck pops up,\u201d he said. \u201cAnd that wasn\u2019t there a month before.\u201d<\/p>\n
Patient and Provider Coalition<\/p>\n
Conway\u2019s Patient and Provider Patient Coalition includes a group of patients, healthcare workers and community organizations \u201cfighting to make health insurance actually work,\u201d according to information on the coalition.<\/p>\n
\u201cIt impacts every single person whether you are poor, middle class or have great insurance from your employer,\u201d Conway said.<\/p>\n
He said other patients have shared many stories of challenges with prior authorizations and claim denials.<\/p>\n
\u201cAnother buddy of mine, his dad had a severe stroke,\u201d he said, and the insurance company denied coverage at the rehab center.<\/p>\n
Instead, the man was sent to a long-term care facility that does not have any specialty services for those who have had a stroke, Conway said.<\/p>\n
\u201cHe is still not recovered at all,\u201d he said.<\/p>\n
Kim Adamski\u2019s husband, takes a biologic TNF inhibitor, a specialty medicine keeping him in remission from Crohn\u2019s. But his insurance company denied coverage for the original medication and paying just 50% of the cost of a generic drug.<\/p>\n
\u201cThere are assistance programs but they are unreliable and often require hours per month on the phone with our insurer,\u201d Adamski said. \u201cThis has caused him to be late on his medication for the past four months.\u201d<\/p>\n
Reducing prior authorizations in state health insurance<\/p>\n
State Comptroller Sean Scanlon said it \u201cused to be that we lived in a healthcare system where you got sick, you went to the doctor and the doctor who is a professional decides the best course of care for you is and you get that care and your insurance company pays for it.<\/p>\n
\u201cWe\u2019ve increasingly become a society in which the insurers are playing doctor and intervening in your healthcare decisions between you and your doctor,\u201d he said. \u201cThat\u2019s a bad development in our healthcare system.\u201d<\/p>\n
Scanlon said when he went to renegotiate the contract for the first time regarding the state health insurance plan, \u201cwe insisted on dropping the number of prior authorizations required.<\/p>\n
\u201cWe said \u2018if you want to do business with the state, you\u2019ve got to do less prior authorizations,\u2019\u201d\u00a0 he said.<\/p>\n
The change to the state\u2019s health insurance plan, which serves 270,000 state employees including 60,000 retirees, has resulted in a lower denial rate of 6.3%, approximately half that of the commercial payer industry.<\/p>\n","protected":false},"excerpt":{"rendered":"When Matt Conway tore his bicep delivering a table recently, there were numerous barriers to getting it fixed.…\n","protected":false},"author":2,"featured_media":719434,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[103703,309755,15907,150918,136618,157673,2000,15861,50694,309758,15862,97,252,9041,253,983,168221,33270,216321,204512,309757,309756,26587,148964],"class_list":["post-719433","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-american-medical-association","tag-anthem-blue-cross-blue-shield","tag-care","tag-cigna","tag-claim-denials","tag-connecticare","tag-connecticut","tag-ct-news","tag-delay","tag-deny","tag-hartford-courant","tag-health","tag-health-care","tag-health-insurance","tag-healthcare","tag-local-news","tag-max-image-preview","tag-prior-authorization","tag-sen-matt-lesser","tag-sen-saud-anwar","tag-the-connecticut-insurance-department-report-card","tag-the-riseup","tag-treatment","tag-united-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/719433","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=719433"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/719433\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/719434"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=719433"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=719433"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=719433"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}