One Size Does Not Fit All: An All-Too-Common Dilemma for Physicians Subject to Pre-Authorization Requirements

The following post by Dr. Zilin Wang describes the frustration faced by physicians whose treatment plan for their patients run afoul of insurance mandated cost-savings requirements that delay access to needed services:

This week, insurance companies have put me in the awkward position. I will be wrong no matter what I would do. One of my patients has abnormally high on special cholesterol called LP(a). It is the worst cholesterol that you can have causing plaques building up in your arteries. Study has shown that statins don’t work. I have prescribed a different cholesterol pill for the patient. 

Automatically, preauthorization( PA) started. Because they all want me to start a cheaper drug first, they asked me: have you tried any of the statins? did they have any intolerable side effects? Of course, my answers were no. I was quickly rejected. I appealed with my reasoning; they rejected me again. 

Now, knowing that statins are not working on this kind of disease, I am facing choices: 

1. Starting one of the statins, it will bring in no efficacy but only potential side effects. If I do so, I am morally wrong, it is against my professionalism. 

2. I prescribe no medicine and leave the patient alone. I’m wrong because it could cause problem progression. 

3. I prescribe medication without approval; the patient has to pay out of pocket. 

What should I do? It’s a typical case that doctors are no longer in the driver seats, we have businesspeople sitting behind the desk and telling us what to do. There is no concern about patient wellbeing, doctor’s opinion. They don’t know patients, and they don’t care! Welcome to American healthcare system where money first, patient is a commodity.

Can health systems do a better job of balancing cost-savings with responsiveness to individual patient’s needs? Clearly, the answer is yes but how is that outcome to be achieved? Will AI save the day? 

Join us at Building Bridges 2026 to explore ways to improve patient care while respecting the bottom line.  Thank you, Dr. Wang, for allowing me to share your post (and your frustration).