Your doctor refers you to a specialist but your insurance blocks the referral.

醫生推薦您去看專科醫生，但您的保險卻阻止了轉診。

Call me to defend why you think this patient needs this.

請打電話給我，為你認為這位病人需要這樣做的理由辯護。

That causes you to go blind.

這會導致你失明。

Imagine you have multiple sclerosis without warning.

想象一下，你在毫無徵兆的情況下患上了多發性硬化症。

Your insurance stops your medications.

您的保險停止了您的藥物。

No, you cannot give this drug.

不，您不能使用這種藥物。

So you become paralyzed.

於是你就癱瘓了。

Imagine your father has cancer.

想象一下，你的父親得了癌症。

His doctor orders an MRI.

醫生給他做了核磁共振成像。

No, you cannot order this image prescribes chemotherapy.

不，您不能訂購此影像的化療處方。

Have you considered this other less expensive option?

您是否考慮過其他更便宜的選擇？

His insurance causes delay after delay.

他的保險造成了一次又一次的延誤。

No, you don't need this surgery.

不，你不需要這個手術。

He dies.

他死了

An absurd process has infiltrated American health care.

一個荒謬的過程已經滲透到美國的醫療保健領域。

It's called prior authorization.

這叫事先授權。

Here's how it works before your doctor provides a treatment.

在醫生提供治療之前，先來看看它是如何工作的。

Your insurance requires them to prove it's necessary.

您的保險要求他們證明這是必要的。

This is often a time consuming process that can cause dangerous delays.

這通常是一個耗時的過程，可能會造成危險的延誤。

I'm sorry your cancer could be cured, but we need to wait for the insurance company to approve your chemotherapy.

很遺憾你的癌症可以治癒，但我們需要等待保險公司準許你接受化療。

That's doctor Jane, she's barricaded by prior authorizations daily.

那是簡醫生，她每天都被事先授權書擋在門外。

This is a really big issue and it impacts every single person in this country who has insurance.

這確實是一個大問題，它影響著這個國家每一個有保險的人。

Prior authorization was actually created to save you money decades ago.

事先授權實際上是幾十年前為節省費用而設立的。

It was used sparingly only to make sure expensive treatments like long hospital stays were absolutely necessary.

只有在確保長期住院等昂貴治療是絕對必要的情況下，才會慎重使用。

But now it's devolved into now a system where a lot of times things are really denied for no reason.

但現在，它已經演變成一種制度，很多時候，事情真的會無緣無故地被拒絕。

Even everyday medications now require insurance approval could be for medications to treat heartburn.

現在，即使是日常用藥，治療胃灼熱的藥物也需要保險準許。

A DH D medication test strips for patients to be able to check their blood sugar chemotherapy PROzac.

為患者提供 DH D 藥物試紙，以便他們能夠檢查血糖化療百憂解。

When I prescribe a medication, I would say 95% of the time I have to obtain a prior authorization.

當我開藥時，95% 的情況下我都必須獲得事先授權。

New York Times opinion interviewed more than 50 doctors and patients.

紐約時報》的觀點採訪了 50 多名醫生和患者。

Their experiences suggest that insurance companies often weaponize this mundane process in order to control doctors and inflate their profits if they deny care or they delay care.

他們的經驗表明，保險公司往往將這一普通程序武器化，以控制醫生，並在醫生拒絕治療或拖延治療的情況下誇大利潤。

That's money.

那就是錢。

The insurance company gets to keep the way that they profit is to deny care as prior authorization has spread, delays in care have become normalized.

保險公司獲利的方式就是拒絕提供醫療服務，因為事先授權已經蔓延開來，醫療服務的延誤已經常態化。

So have tragedies.

悲劇也是如此。

One in three doctors say that it's caused a serious medical issue or even the death of one of their patients.

每三名醫生中就有一名說，它導致了嚴重的醫療問題，甚至造成一名病人死亡。

Ocean went blind.

海洋失明瞭。

It was like the insurance company telling me that my life didn't matter, Michael couldn't walk or stand for four months.

這就像保險公司告訴我，邁克爾四個月不能走路或站立，我的生命就不重要了。

It's like I am scared of MS but my fear as of right now is more of the insurance company and Vivian lost her father.

就像我害怕多發性硬化症一樣，但我現在更害怕的是保險公司和薇薇安失去了父親。

I spent so much time on the phone writing letters faxing that I didn't get to spend that time with my father, this is medical injustice disguised as paperwork.

我花了那麼多時間打電話寫信發傳真，卻沒能好好陪陪父親，這是偽裝成文書工作的醫療不公。

When your prior authorization is denied, you have three options.

如果事先授權被拒絕，您有三種選擇。

You could just pay out of pocket.

你可以自掏腰包。

But healthcare is so ridiculously expensive.

但醫療費用貴得離譜。

That that's not realistic.

這是不現實的。

You can give up.

你可以放棄。

That's what happens up to 80% of the time a win for your insurance company or your doctor can go to bat for you.

在多達 80% 的情況下，保險公司或醫生都會為你打贏官司。

When our prior authorizations get denied, we have to do what's called a peer to peer.

當我們的事先授權被拒絕時，我們必須進行所謂的點對點授權。

A peer to peer is supposed to be a phone call where you call somebody who is your peer to justify the treatment that you want to deliver.

所謂 "同伴對同伴"，就是打電話給你的同伴，讓他證明你要提供的治療是正確的。

I'm a pediatrician and sometimes I'll end up talking to a neurologist, people who couldn't pronounce the names of the drugs.

我是一名兒科醫生，有時我會與神經科醫生交談，他們連藥物名稱都讀不出來。

I was trying to prescribe often.

我是想經常開處方。

It's not even a physician.

它甚至不是一名醫生。

Now, imagine you have to do that 5 to 10 times a day.

現在，想象一下你每天要做 5 到 10 次這樣的工作。

What's even more ridiculous about this whole process is that after we go through all of this, if you're really a determined provider, you'll probably get your drug or your procedure authorized.

更可笑的是，在整個過程結束後，如果你真的是一個有決心的醫療服務提供者，你很可能會得到藥物或手術的授權。

Insurance companies say that this process helps reduce the cost of expensive treatments, ensure safety and lower the total cost of care.

保險公司表示，這一過程有助於降低昂貴的治療費用，確保安全，並降低護理的總成本。

But what it's actually doing is creating a lot of expensive bureaucracy.

但實際上，它正在製造大量昂貴的官僚機構。

We have four full time employees who their sole focus is on obtaining prior authorization for medications to treat Crohn's disease and ulcerative colitis.

我們有四名全職員工，他們唯一的工作就是為治療克羅恩病和潰瘍性結腸炎的藥物獲得優先授權。

And that's just for one disease state.

而這僅僅是針對一種疾病狀態。

By one estimate, the US spends about $35 billion a year on the administrative costs of prior authorization, these resources could be devoted to patient care, answering phones in a timely fashion.

據估計，美國每年在事先授權的行政成本上花費約 350 億美元，而這些資源本可以用於病人護理、及時接聽電話。

I might actually get to go home and see my family on a regular basis.

我可能真的能經常回家看看家人了。

In an admission of sorts.

在某種程度上承認了這一點。

Some companies have actually pledged to reduce prior authorizations but those efforts only scratch the surface.

一些公司實際上已經承諾減少預先授權，但這些努力只是表面文章。

I am a board certified gastroenterologist.

我是一名經過認證的胃腸病專家。

I know what I'm doing only to be blockaded by all of this bureaucracy red tape which really only serves to enrich the insurance companies.

我知道自己在做什麼，但卻被這些官僚主義的繁文縟節所阻撓，而這些繁文縟節實際上只是為了讓保險公司更有錢。

Cigna made $5.2 billion in profit.

Cigna 盈利 52 億美元。

Last year elev made 6 billion United Healthcare made $22 billion.

去年 elev 賺了 60 億美元，United Healthcare 賺了 220 億美元。

I had a patient who had a new diagnosis of lymphoma and the insurance company was giving us a hard time to give the chemotherapy.

我有一個新診斷為淋巴瘤的病人，保險公司對我們進行化療很刁難。

I got someone on the phone and I told the person I said I need your name because when this young man dies, I want to tell his parents who was the reason behind it.

我找人打電話，告訴對方我需要你的名字，因為這個年輕人死後，我想告訴他的父母誰是幕後黑手。

I went home and I cried after I hung up the phone because I was so emotionally exhausted and that was just one patient.

我回到家，掛斷電話後我哭了，因為我已經精疲力竭了，而這只是一個病人。

I had seen 25 other patients that day and many of them would eventually need prior authorizations as well.

那天我還看了另外 25 位病人，其中很多人最終也需要事先授權。

Prior authorization gives your insurance company more power than your doctor.

事先授權賦予保險公司比醫生更大的權力。

Now, there are some complicated cases when it makes sense to double check that your doctor isn't unnecessarily overprescribing.

現在，在一些複雜的情況下，仔細檢查醫生是否開了不必要的過量處方是有意義的。

Imagine you've had a cancerous tumor removed to be extra safe.

想象一下，為了更加安全，你已經切除了一個癌症腫瘤。

Your doctor recommends an additional treatment, but it costs 100 and $70,000.

您的醫生建議進行額外的治療，但需要花費 100 美元和 70 000 美元。

On the one hand, I can see where insurance companies are coming from with, you know, wanting to take a careful look at these expensive treatments.

一方面，我能理解保險公司的出發點，你知道，他們希望仔細研究這些昂貴的治療方法。

Then on the other hand, I'm a human and I'm a young mom.

但另一方面，我也是一個人，一個年輕的母親。

What's my life worth?

我的生命有什麼價值？

Sarah's insurance denied the treatment.

莎拉的保險拒絕了治療。

The question is, do you think they made that decision based on what was in her best interest or theirs in many countries?

問題是，你認為他們是根據她的最大利益還是許多國家的最大利益做出這一決定的？

These tough ethical decisions about what is covered are made by governments not for profit insurance companies.

這些關於承保範圍的艱難道德決定是由政府非營利性保險公司做出的。

The government should abolish prior authorization or at the very least reform it.

政府應取消或至少改革事先授權。

My goal with Senate Bill 247 is to reform the prior authorization process.

我提出參議院第 247 號法案的目的是改革事先授權程序。

Bill 3459 creates a streamlined prior authorization process known as quote gold carding.

第 3459 號法案創建了一個簡化的預先授權程序，稱為 "報價金卡"。

A handful of states have created gold card programs.

少數幾個州制定了金卡計劃。

Doctors who have successfully obtained prior authorizations in the past are exempt from needing to obtain them again.

過去已成功獲得預先授權的醫生無需再次獲得預先授權。

All states and the federal government should pass laws like these.

所有州和聯邦政府都應該通過這樣的法律。

Your insurance should not be a barrier between you and the health care you need.

保險不應成為您獲得所需醫療服務的障礙。

I finally got the authorization to see the neuro ophthalmologist after 12 weeks and he said we're gonna do the surgery, but it's only to preserve the vision you have left if we had seen you earlier.

12 周後，我終於拿到了去看神經眼科醫生的授權，他說我們要做手術，但這只是為了保留你的視力，如果我們能早點看到你的話。

That would have been a different story.

這將是一個不同的故事。

Maybe I'll be able to see now.

也許我現在能看見了。

Maybe I'd have a different life.

也許我會有不同的人生。