BY SALLY NIX

For too long, health insurance companies have dictated patient care instead of doctors. The bureaucratic nightmare of prior authorization, which requires doctors to obtain insurer approval before treating their patients, has delayed or outright denied life-saving medical care. Too often, the consequences have been devastating.

As someone who has battled disabling illness and navigated North Carolina’s healthcare system, I know firsthand how harmful this process can be. It is a relentless labyrinth filled with constant back-and-forth with insurers, long delays for necessary treatments, arbitrary denials, and a never-ending fight to prove that my care matters and that my physician knows best.

Unlike most people, I had a solid grasp of the health insurance system and knew where to turn to advocate for myself when I was denied life-changing treatment. I was fortunate to secure a hard-fought victory against my insurance denial, but the battle was anything but easy. Every step of this struggle has only strengthened my resolve to ensure that no one else in our state faces these same obstacles.

Imagine a mother in North Carolina, facing aggressive cancer, forced to wait weeks for approval before starting treatment—despite her oncologist’s warning that every day matters. Picture a child in need of specialized mental health care being told by an insurance company—not their doctor—that they don’t qualify. Consider a dying patient in pain, left to suffer, while their hospice physician fights an uphill battle to get approval for medication that could ease their suffering.

These aren’t hypotheticals. These are the lived realities of too many North Carolinians. But there’s hope—because North Carolina is leading the charge.

House Bill 434: The Care First Act

House Bill 434, the Care First Act, is one of the nation’s most comprehensive prior authorization reform bills. If passed, it will bring transparency, efficiency, and accountability to a system that insurance companies have manipulated for far too long. This bill ensures that medical decisions are made by qualified healthcare providers—not by insurers with a profit-driven agenda.

The consequences of prior authorization—a fundamentally broken system—aren’t just frustrating. They can be deadly. A 2022 survey by the American Medical Association found that nearly one in three patients have suffered serious harm due to prior authorization delays. Many have been forced into emergency rooms, hospitalized, or left with permanent health setbacks.

And some never got the chance to fight for their care—because an insurance company’s “wait” or “no” became a death sentence.

For patients with rare diseases, disabilities, and chronic conditions, the burden is even heavier. Those who require ongoing care often face repeated prior authorization requests, even for medications and treatments they have relied on for years. Why should a paralyzed veteran have to prove every few months that they still need a wheelchair? Why should a stroke survivor have to fight to keep the therapy that helps them walk again?

Meanwhile, physicians across North Carolina are drowning in bureaucratic obstacles that prevent them from providing proper care. On average, doctors spend 13 hours a week navigating prior authorization requirements—nearly two full business days lost to paperwork instead of patient care.

Insurance companies have all the power—they can delay approvals, deny treatments outright, and force patients to abandon necessary care or pay exorbitant medical bills out of pocket.

Worse, these decisions are often made by insurance-employed doctors who lack the necessary expertise to assess a patient’s condition. In my case, a retired OB/GYN was responsible for determining the denial for a rare and complex neurological condition. Tragically, some patients don’t survive long enough to win their appeals.

No patient should die on hold, and no physician should have to beg an insurance company to provide the care their patients desperately need.

Holding Insurers Accountable

It is past time that health insurance companies were held responsible for the outcome of care denials. Currently, insurance company doctors are not required to hold a license to practice in North Carolina. This means that when an out-of-state doctor employed by an insurer denies life-saving care and the patient has a bad outcome, their license remains untouched. They face no accountability for the consequences of their decisions.

This bill addresses the issue head-on. It requires that any doctor involved in patient care decisions—whether directly treating patients or making determinations on behalf of insurance companies—be licensed to practice in North Carolina. This ensures consistent professional and ethical standards, whether the physician delivers care or decides if a patient will receive it.

Crucially, the bill holds these doctors fully accountable for their decisions. They will be held responsible for providing necessary care or blocking access. Insurance companies can no longer use out-of-state or unqualified doctors as a shield to justify life-altering denials.

Putting Patients First

North Carolina has a real opportunity to lead the nation in healthcare reform. With the introduction of House Bill 434, our state is showing that meaningful reform is possible when lawmakers put patients before politics.

The Care First Act addresses some of the most harmful insurance practices. It would require insurers to consult with a patient’s physician before denying care, ensuring that medical decisions are made by those who actually treat patients—not insurance companies looking at the bottom line. It also sets strict time frames for decisions so patients aren’t left in limbo when urgent care is needed. By promoting continuity of care and limiting retrospective denials, this bill provides essential safeguards to keep patients from being blindsided by coverage changes or after-the-fact claim rejections. This is a critical step toward a healthcare system that prioritizes patients!

But passing this bill will take voices, stories, and action from the people who need it most—you.

I urge my fellow North Carolinians to join me in demanding change. It’s time for us to take a stand. We need to make our voices heard so that insurance companies can no longer play doctor with our lives.

Here’s how you can help:

♦ Contact your NC lawmakers. Patients and physicians need to tell them why House Bill 434 matters. Demand that they stand with patients, not insurance companies.

♦ Share your story. Speak out if you or a loved one has faced delays or denials due to prior authorization. Legislators need to hear the actual impact.

We, the patients, urgently need a more compassionate, patient-centered healthcare system. The question is simple: Will we stand up for patients or continue to let insurance companies dictate our healthcare?

North Carolina is ready to lead. Let’s make sure our lawmakers lead with us.

Sally Nix lives in Statesville.