BISMARCK, N.D. (KFYR) – If you’ve had to get prior authorization for medical care, you know just how complicated the topic can be. Basically, it means your insurance company needs to approve certain services before your healthcare provider can prescribe them to you.

When KFYR Reporter Elizabeth Shores spoke with Carrie Varner nearly a month ago, her life looked like this. However, now that she’s changed insurance plans, jaunts through the park might be few and far between.

She used to have multiple asthma attacks a week before starting the injectable medication Xolair, which she said costs nearly $60,000 a month without insurance coverage. She said her doctors helped her file an application for a manufacturer’s discount, but earlier this month, they denied her request. She said now, her co-pay is nearly $2,600.

“It’s just going to be like, ‘Okay, what’s going to set it off today? What’s going to make it so that it’s a fatal issue? What’s going to make it so that I don’t have much of a quality of life anymore?‘” Varner said.

It took months of back and forth between her doctors and her insurance company in order for her to be prescribed Xolair in the first place— she appealed their prior authorization denials eight times. She said she’ll have to go through it again if she wants to get back on the medication in the future.

Pulmonologist Dr. Alfredo Iardino at CHI St. Alexius in Bismarck said it’s an issue pretty much every single one of his patients has.

“It basically will increase their chances of coming to the hospital, increase their chances of serious complications, and in my case, in the respiratory world, end up with a COPD or asthma exacerbation in the ICU,” Dr. Iardino said.

North Dakota Hospital Association President Tim Blasl said it’s likely that many insurance companies already work with doctors and follow a standard procedure when authorizing medical services; he said this bill will require them to respond to consumers with their authorization decisions within a certain time frame and could provide automatic approvals on claims where companies don’t respond quickly enough.

“This makes it a little more standard, and so all the insurance companies have to follow this, again, in terms of commercial. So, that just helps people that are seeking prior authorization. There’s some consistency because there is no consistency today,” Blasl said.

In their testimony, representatives from Blue Cross Blue Shield wrote: “Prior authorization serves as an important safety check— confirming together with the provider that what they are recommending is safe, medically evidenced and not duplicative.”

They say it’s a necessary inconvenience to ensure consumers are receiving legitimate, evidence-based care. For people like Varner, though, time is of the essence.

We reached out to multiple insurance company representatives for comment, but haven’t heard back. Varner said she’s been mostly homebound since she ran out of her medication. The bill was passed by the Senate earlier this month. It goes through the House next.

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