Is bigger better when it comes to health care providers? 

Excessive demands for insurance preauthorizations can lead to fatal delays in diagnosing the many conditions that plague West Virginians

July 13, 2023 6:00 am
A closeup of the blue WVU Medicine, Thomas memorial Hospital sign. Right under it is a red sign with a left arrow point to the emergency center.

Thomas Memorial Hospital in South Charleston is part of WVU Medicine. (Lexi Browning | West Virginia Watch)

I am a West Virginian. 

Although the birth certificate reads New Delhi, India as my place of birth, I became a daughter of West Virginia at 9-months-old when my parents adopted me. I have lived in these hills ever since.

My father took me to fly kites on the property that is now Cabell Midland High School. I remember when Pullman Square was being built in the 1990s and 2000s. I smiled as The Market was put in and a bustling downtown Huntington continued to blossom.

There are many wonderful things this state is doing to help care for its residents. The mobile dentist program that comes to my children’s school is amazing. It has helped my family so much, and I’m thankful our state has this for our children. Every child deserves a beautiful smile. Especially because our dental health impacts our overall health.

The state faces many problems that impact West Virginians’ wellness. The environmental and health effects of the coal-mining industry, the opioid crisis — the blight of these spread through the state like any sickness — and many do cause severe illness and death.Luckily, West Virginia’s health care system is growing. West Virginia University continues to expand, and it looks like Marshall Health, with the help of Mountain Health Network, will continue to do the same.

To some, it might look like we really are heading toward the peak of health care. “Look at how good this is for the community! Bringing health care to everyone!”

But what happens when the leadership is questionable? After all, there are many factors involved when it comes to quality health care. Are they listening?

The saying may be “bigger is better,” but that’s not always the case. Problems — like those our state faces in providing health care — do not get better as they get bigger. They bleed into the future.

To have a successful health care experience, a patient needs to have support from their medical professionals. And it helps when the people we turn to are being taken care of:  doctors, nurses and assistants should only be worrying about the health of the person in front of them and making sure they give them compassionate care.

Doctors and staff should be set up for success when they have our lives in their hands. But in rural areas, we deal with understaffing. We deal with transportation issues. Heck, we deal with a lot.

But what happens to you when you get to the doctor’s office, and you need tests in order for your doctor to find out what exactly is wrong? Here come the preauthorizations. And those can be deadly.

By requiring excessive preauthorizations, insurance organizations are making it harder for our doctors to do their jobs. Patients are left with a later diagnosis. The care also becomes more expensive. On top of that, health insurance companies have found new ways to cut their costs by rejecting claims without reading them at the expense of those they are paid to help.

As for public employees’ care, the state’s Public Employees Insurance Agency’s freefalling financial crisis is hurting patients. The politicians like to talk about how the PEIA has dropped the ball, but it’s important to remember who appoints people to oversee PEIA

Growing up with PEIA, I rarely was able to get the care that was prescribed to me. Amazing doctors would complain about how “insurance plays doctor” and denies preauthorizations. What happens when you have to wait for them? In rural areas, we are more likely to get a later diagnosis. The 14 days it can take to get the authorization for a lab test can mean life or death. With the newly founded Peak Health being formed to help combat these issues, I was initially optimistic. However, after looking at the website itself and seeing all the things that required preauthorization, I was disheartened. 

Like in this instance, about coverage for breast cancer mammograms.

When a doctor recommends a mammogram, it should be done. It should never be called “investigational and not medically necessary.” Many of these factors depend on medical history also. What happens if you don’t have a medical history pointing to breast cancer? Don’t worry. The test for the BRCA gene can be done. But that needs preauthorization too.

The stats on W.Va.

  • The injury mortality rate is 70% higher than the national average
  • The diabetes mortality rate is 53% higher
  • Chronic Obstructive Pulmonary Disease mortality rate is also 53% higher
  • The heart disease mortality rate is 19% higher
  • The stroke mortality rate is also 19% higher
  • The cancer rate is 17% higher

From West Virginia’s 2017 Rural Health Plan

You can have all the fundraisers for health care you want. But if the administration at the top doesn’t let it trickle down to better patient care, you’re just putting money in their pockets.

It makes me think that was the point all along. To make the wealthy richer, and to just hope and pray for our health. We do have a large amount of illness. Could any of this be because of the environmental issues these extraction companies can cause?

State employees deserve the best care. Our teachers are raising the future. Our librarians are helping combat illiteracy daily by creating programs for children and adults. Our Department of Motor Vehicle workers deal with the public every day.

It’s not the people who need and deserve the help most who are benefitting. We are left fighting for our lives.

Everyone wants to see West Virginia win, but it should be patients, staff and doctors who thrive. Not just companies.


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Neera Doss Burner
Neera Doss Burner

Neera Doss Burner is a mother, daughter and friend living in West Virginia. She writes about disability justice, video games and the adoptee experience in Appalachia. Her bylines include Love What Matters, Black By God, Huntington News Network and IGN Entertainment. You can find out more about Neera at her blog she’s owned and operated since 2018,