RALEIGH – On January 28, 2025, the North Carolina Medical Society put prior authorization reform in the spotlight at a press conference at its Raleigh headquarters.
Lawmakers, physicians, advocates, and a cancer patient came together to highlight the inefficient, outdated, costly, and often life-threatening nature of the current prior authorization process. To help make the case for reform, Amanda Watson, a stage 4 metastatic breast cancer patient, detailed her long and painful journey through chemotherapy, radiation, and surgery. She described her diagnosis—just three weeks after the birth of her second son—as shocking. She spent the first months of his life unable to hold or feed him, a time she says was made even more difficult by delays in care due to prior authorization denials.
“It’s hard not to waver in your convictions and not to lose hope during this type of battle,” she said. “When an insurance company can so blindly look at you—not as a person, not as a wife, not as a daughter, not as a mother of two babies … just as a simple word, ‘approved’ or ‘denied.’”
Rep. Timothy Reeder (R-Ayden) was also present. “The time is really now,” he said. “For the Senate to not take up this bill, not hear it, not work on this bill, is something that we’re going to push hard on, both personally and as a chamber.”
Rep. Grant Campbell (R-Concord), a physician, also spoke. He described his experience with prior authorization: “This is about forcing patients and physicians to settle for cheaper, less effective care, or ultimately hoping the patient gives up and pays out of pocket,” he said. As an OB-GYN, Campbell talked about how upsetting it is to be told how to treat a patient by someone who is not in the same field. He emphasized that peer-to-peer reviews are an absolute necessity and that insurance companies are not providing them.
NCMS Board of Directors President Dr. John Meier stated that insurance companies look at costs and may base prior authorization decisions on financial considerations. In contrast, he said, providers focus on the long-term health of the patient. He also argued that the administrative burden on providers and staff takes away valuable time that could be spent caring for patients.
SIGN THE NCMS PRIOR AUTHORIZATION PETITION NOW!
In attendance were:
- Rep. Allen Buansi (D-Dist. 56)
- Rep. Grant Campbell, MD (R- Dist. 83)
- Rep. Maria Cervania (D-Dist. 41)
- Rep. Allen Chesser (R-Dist. 25)
- Sen. Mark Hollo (R-Dist. 45)
- Rep. Timothy Reeder, MD (R-Dist. 9)
- Rep. Donna White (R-Dist. 26)
For those who missed the event, a re-play is available on Facebook Live here.
Special thanks to the Watson family for courageously sharing their story, and to the many news outlets that covered this vital issue, including NC Insider, The Associated Press, WRAL, UNC, NC News Network, WPTF Radio, and Curtis Media Group.
Links to coverage of the NCMS Prior Authorization Press Conference:
- The News & Observer, Reform or ban? Prior authorization for health insurance is under negotiation in NC
- WRAL, North Carolina doctors, patients, lawmakers call for health insurance reform in 2025
- State Affairs, Prior authorizations at issue: Lawmakers call for health insurance reform
- WCNC Charlotte, Advocates call for health insurance reforms in North Carolina
- NC HealthNews, ‘Approved or denied’: Health care providers say insurers too often deny care for profit
- INsurance Newsnet, NC bill would limit insurers’ prior authorizations. Proposed NC bill limits reach of insurers’ prior authorizations
Additional reading from NCMS:
- NCMS Pushes for Prior Authorization Reform with Bipartisan Support from Lawmakers
- NCMS CEO Chip Baggett Featured in Podcast About Prior Authorization
- States Cranking Up Oversight of Health Insurers, NCMS Focusing on Prior Authorization in 2025
- The North Carolina Medical Society’s highest advocacy priority to REFORM PRIOR AUTHORIZATION NOW
SIGN THE NCMS PRIOR AUTHORIZATION PETITION NOW!