Latest news with #Ekirch
Vox
4 days ago
- Health
- Vox
Can't sleep? It's not totally your fault.
For much of history, humans probably got pretty lousy sleep. Prior to the Industrial Revolution, many people slept in the same bed alongside their family in dwellings lacking any temperature control beyond a fire or air ventilation. Those homes were littered with bed bugs, fleas, and lice that not only feasted on their hosts at night but also spread diseases, which — in the absence of modern medicine — kept the infirm awake and suffering. The noises of cities and rural life alike also made sleep difficult, thanks to the all-hours bustling of laborers, horse-drawn carriages, and livestock with whom farmers might've shared a home. 'Because in the winter they generated warmth,' says A. Roger Ekirch, a history professor at Virginia Tech and author of At Day's Close: Night in Times Past. Nighttime itself was a risk. Slumber left people vulnerable to crime or death from fire or other natural disasters. Some prayers throughout history sought God's protection from the litany of threats adherents encountered in the dark, says Ekirch. For those who are lucky enough to have access, modern marvels like central heating and air conditioning, comfortable beds, and even Tylenol have all but eliminated many of these barriers to sleep. 'We don't have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago,' Ekirch says. 'We don't have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago.' Still, sleep doesn't come easily to millions of Americans. Over 14 percent of adults had trouble falling asleep most days in 2020, according to the National Health Interview Survey. Nearly just as many people — 12 percent — have been diagnosed with chronic insomnia, according to an American Academy of Sleep Medicine survey. Among the 33 percent of US adults who get less than seven hours of sleep a night, native Hawaiian or Pacific Islander and Black adults are the most likely to get shorter durations of shut-eye. Those with an annual household income of less than $15,000 are also likely to be sleep-deprived. Despite seemingly prime conditions for sleep, why do so many suffer from restless nights? The most comfortable bed in the darkest room might not be enough to overcome a mix of environmental, systemic, and behavioral forces preventing quality slumber. Modern lifestyles aren't ideal for sleep American sleep culture is marked by contradictions. Anyone who's endured a night of terrible sleep can attest to its importance in cognitive functioning, mood, hunger, and overall health. Yet, many people act in ways that sabotage their hope for a good night's sleep. We stay up later than we should to catch up on work or news or precious free time — what is sometimes called revenge bedtime procrastination. We consume content on our phones so upsetting or attention-grabbing as to prevent our falling asleep, although many of us know by now that screen use an hour before bed results in delayed bedtime and less sleep overall. We settle into bed and realize that late-afternoon coffee or nightcap too close to bedtime has come to collect its vengeance. Some people innately need more sleep than others, and these so-called long sleepers simply cannot find the time in their busy schedules to devote to 10 hours of slumber. Try as we might to have it all, optimizing our waking hours might come at the detriment of our sleep. 'We're trying to have our cake and eat it, too,' Ekirch says. 'The less time we accord to sleep, the more perfect we want it to be for when we do nod off.' Ironically, a population of people with no notable sleep issues has turned sleep into a competitive sport, leveraging mouth tape, expensive mattresses, and sleep trackers like the Oura Ring in pursuit of the perfect night's sleep. This fixation on enhancing sleep may actually do more to promote insomnia than peaceful slumber, experts say. Most disruptions to sleep cannot be blamed on personal choices, though. Parents and other caregivers are among the most sleep-deprived, often contending with their children's inconsistent sleep schedules. And the sleep patterns of shift workers — which account for 20 percent of the US workforce — are dictated by their employers. The ill effects of poor sleep can negatively impact mental health. The opposite is true, too: Mental distress has consequences for sleep. 'Stress, anxiety, weird work schedules,' says Jessi Pettigrew, a clinical social worker who focuses on sleep disorders, 'can lead to the development of sleep disorders like insomnia or circadian rhythm disorders, which basically means being misaligned with your biological sleep schedule because of social reasons.' Environmental and systemic barriers can disrupt sleep Outside of individual behavior, where we live has a role in sleep. Not having the ability to control the temperature in your bedroom because you lack effective heating or air conditioning can be a barrier to sleep, Pettigrew says. If you feel unsafe in your environment, you're less likely to get restful slumber, too, she adds. This tends to impact people with housing insecurity, refugees, and those who are incarcerated. Beyond the bedroom, noise and light pollution from bright street lights and traffic have been shown to interrupt sleep and contribute to insomnia — and those in low-income neighborhoods are more susceptible to these conditions. 'People who live in places with good natural light, green spaces, the ability to control the temperature and light and noise in their environment,' Pettigrew says, 'helps them to sleep better and better regulate their circadian rhythm during the day and sleep at night.' All of our waking experiences impact our ability to sleep, says Anita Shelgikar, a neurology professor at the University of Michigan Medical School and the president of the American Academy of Sleep Medicine board of directors. And some of those waking experiences may be colored by racism and discrimination. Stress associated with racial discrimination has been linked to poor sleep. Among shift workers, people of color are more likely to work alternating day/night schedules, resulting in disrupted circadian rhythms. 'If that disrupts your sleep enough, that technically qualifies as shift-work sleep disorder,' says Jade Wu, a behavioral sleep medicine psychologist and author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. This disorder is marked by excessive sleepiness, insomnia, or both. The knock-on effects of altered sleep-wake schedules are profound, ranging from cardiovascular disease and obesity to mood and immune disorders. 'Sleep health disparities disproportionately affect the same populations who suffer from overall health disparities,' Shelgikar says. Those in rural or low-income areas who generally lack access to healthcare, let alone specialized sleep medicine, may continue to suffer from poor sleep, in addition to any number of physical and mental health conditions. Without individualized care, Shelgikar says, the disparities may only widen. How to overcome these sleep obstacles If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you're sleepy can seem trite. Wu suggests identifying the environmental or circumstantial reason you aren't getting restful sleep and doing whatever you can to mitigate it. For those who live in spaces that aren't conducive to sleep — hot bedrooms or the constant wail of sirens all night — there are few things people can do beyond getting a fan or earplugs, Wu says. People with means and flexibility can seek out a doctor specializing in sleep medicine to diagnose potential disorders like insomnia or sleep apnea. If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you're sleepy can seem trite. But if your conditions for sleep are pretty good and you still struggle to get shut-eye, the key, according to Wu, may be to not obsess over it as much. 'What you see in people with insomnia is that they're trying too hard,' she says. 'They're tracking their sleep too closely. They are perfectionistic about their sleep hygiene and doing things like going to bed too early or trying to take too many naps, trying to achieve a certain number of hours of sleep, or a certain score on their sleep tracker.' The human body was meant to sleep. And despite all the constructs and complications society throws our way, we still require sleep. Ironically, though, the more we fret over it, the more elusive it can become. As difficult as it seems, the best advice may be to surrender to the circadian rhythm. 'One thing that can help with sleep,' Pettigrew says, 'is just saying, I'm going to trust my body to take care of this.'
Yahoo
14-07-2025
- Health
- Yahoo
We should be in a golden age for sleep
For much of history, humans probably got pretty lousy sleep. Prior to the Industrial Revolution, many people slept in the same bed alongside their family in dwellings lacking any temperature control beyond a fire or air ventilation. Those homes were littered with bed bugs, fleas, and lice that not only feasted on their hosts at night but also spread diseases, which — in the absence of modern medicine — kept the infirm awake and suffering. The noises of cities and rural life alike also made sleep difficult, thanks to the all-hours bustling of laborers, horse-drawn carriages, and livestock with whom farmers might've shared a home. 'Because in the winter they generated warmth,' says A. Roger Ekirch, a history professor at Virginia Tech and author of At Day's Close: Night in Times Past. Nighttime itself was a risk. Slumber left people vulnerable to crime or death from fire or other natural disasters. Some prayers throughout history sought God's protection from the litany of threats adherents encountered in the dark, says Ekirch. For those who are lucky enough to have access, modern marvels like central heating and air conditioning, comfortable beds, and even Tylenol have all but eliminated many of these barriers to sleep. 'We don't have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago,' Ekirch says. 'We don't have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago.' Still, sleep doesn't come easily to millions of Americans. Over 14 percent of adults had trouble falling asleep most days in 2020, according to the National Health Interview Survey. Nearly just as many people — 12 percent — have been diagnosed with chronic insomnia, according to an American Academy of Sleep Medicine survey. Among the 33 percent of US adults who get less than seven hours of sleep a night, native Hawaiian or Pacific Islander and Black adults are the most likely to get shorter durations of shut-eye. Those with an annual household income of less than $15,000 are also likely to be sleep-deprived. Despite seemingly prime conditions for sleep, why do so many suffer from restless nights? The most comfortable bed in the darkest room might not be enough to overcome a mix of environmental, systemic, and behavioral forces preventing quality slumber. American sleep culture is marked by contradictions. Anyone who's endured a night of terrible sleep can attest to its importance in cognitive functioning, mood, hunger, and overall health. Yet, many people act in ways that sabotage their hope for a good night's sleep. We stay up later than we should to catch up on work or news or precious free time — what is sometimes called revenge bedtime procrastination. We consume content on our phones so upsetting or attention-grabbing as to prevent our falling asleep, although many of us know by now that screen use an hour before bed results in delayed bedtime and less sleep overall. We settle into bed and realize that late-afternoon coffee or nightcap too close to bedtime has come to collect its vengeance. Some people innately need more sleep than others, and these so-called long sleepers simply cannot find the time in their busy schedules to devote to 10 hours of slumber. Try as we might to have it all, optimizing our waking hours might come at the detriment of our sleep. 'We're trying to have our cake and eat it, too,' Ekirch says. 'The less time we accord to sleep, the more perfect we want it to be for when we do nod off.' Ironically, a population of people with no notable sleep issues has turned sleep into a competitive sport, leveraging mouth tape, expensive mattresses, and sleep trackers like the Oura Ring in pursuit of the perfect night's sleep. This fixation on enhancing sleep may actually do more to promote insomnia than peaceful slumber, experts say. Most disruptions to sleep cannot be blamed on personal choices, though. Parents and other caregivers are among the most sleep-deprived, often contending with their children's inconsistent sleep schedules. And the sleep patterns of shift workers — which account for 20 percent of the US workforce — are dictated by their employers. The ill effects of poor sleep can negatively impact mental health. The opposite is true, too: Mental distress has consequences for sleep. 'Stress, anxiety, weird work schedules,' says Jessi Pettigrew, a clinical social worker who focuses on sleep disorders, 'can lead to the development of sleep disorders like insomnia or circadian rhythm disorders, which basically means being misaligned with your biological sleep schedule because of social reasons.' Outside of individual behavior, where we live has a role in sleep. Not having the ability to control the temperature in your bedroom because you lack effective heating or air conditioning can be a barrier to sleep, Pettigrew says. If you feel unsafe in your environment, you're less likely to get restful slumber, too, she adds. This tends to impact people with housing insecurity, refugees, and those who are incarcerated. Beyond the bedroom, noise and light pollution from bright street lights and traffic have been shown to interrupt sleep and contribute to insomnia — and those in low-income neighborhoods are more susceptible to these conditions. 'People who live in places with good natural light, green spaces, the ability to control the temperature and light and noise in their environment,' Pettigrew says, 'helps them to sleep better and better regulate their circadian rhythm during the day and sleep at night.' All of our waking experiences impact our ability to sleep, says Anita Shelgikar, a neurology professor at the University of Michigan Medical School and the president of the American Academy of Sleep Medicine board of directors. And some of those waking experiences may be colored by racism and discrimination. Stress associated with racial discrimination has been linked to poor sleep. Among shift workers, people of color are more likely to work alternating day/night schedules, resulting in disrupted circadian rhythms. 'If that disrupts your sleep enough, that technically qualifies as shift-work sleep disorder,' says Jade Wu, a behavioral sleep medicine psychologist and author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. This disorder is marked by excessive sleepiness, insomnia, or both. The knock-on effects of altered sleep-wake schedules are profound, ranging from cardiovascular disease and obesity to mood and immune disorders. 'Sleep health disparities disproportionately affect the same populations who suffer from overall health disparities,' Shelgikar says. Those in rural or low-income areas who generally lack access to healthcare, let alone specialized sleep medicine, may continue to suffer from poor sleep, in addition to any number of physical and mental health conditions. Without individualized care, Shelgikar says, the disparities may only widen. If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you're sleepy can seem trite. Wu suggests identifying the environmental or circumstantial reason you aren't getting restful sleep and doing whatever you can to mitigate it. For those who live in spaces that aren't conducive to sleep — hot bedrooms or the constant wail of sirens all night — there are few things people can do beyond getting a fan or earplugs, Wu says. People with means and flexibility can seek out a doctor specializing in sleep medicine to diagnose potential disorders like insomnia or sleep apnea. If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you're sleepy can seem trite. But if your conditions for sleep are pretty good and you still struggle to get shut-eye, the key, according to Wu, may be to not obsess over it as much. 'What you see in people with insomnia is that they're trying too hard,' she says. 'They're tracking their sleep too closely. They are perfectionistic about their sleep hygiene and doing things like going to bed too early or trying to take too many naps, trying to achieve a certain number of hours of sleep, or a certain score on their sleep tracker.' The human body was meant to sleep. And despite all the constructs and complications society throws our way, we still require sleep. Ironically, though, the more we fret over it, the more elusive it can become. As difficult as it seems, the best advice may be to surrender to the circadian rhythm. 'One thing that can help with sleep,' Pettigrew says, 'is just saying, I'm going to trust my body to take care of this.'
Vox
14-07-2025
- Health
- Vox
We should be in a golden age for sleep
Nighttime itself was a risk. Slumber left people vulnerable to crime or death from fire or other natural disasters. Some prayers throughout history sought God's protection from the litany of threats adherents encountered in the dark, says Ekirch. Vox Culture Culture reflects society. Get our best explainers on everything from money to entertainment to what everyone is talking about online. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. For those who are lucky enough to have access, modern marvels like central heating and air conditioning, comfortable beds, and even Tylenol have all but eliminated many of these barriers to sleep. 'We don't have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago,' Ekirch says. 'We don't have to worry about the myriad perils to sound slumber and our physical well-being that people did 300, 400 years ago.' Still, sleep doesn't come easily to millions of Americans. Over 14 percent of adults had trouble falling asleep most days in 2020, according to the National Health Interview Survey. Nearly just as many people — 12 percent — have been diagnosed with chronic insomnia, according to an American Academy of Sleep Medicine survey. Among the 33 percent of US adults who get less than seven hours of sleep a night, native Hawaiian or Pacific Islander and Black adults are the most likely to get shorter durations of shut-eye. Those with an annual household income of less than $15,000 are also likely to be sleep-deprived. Despite seemingly prime conditions for sleep, why do so many suffer from restless nights? The most comfortable bed in the darkest room might not be enough to overcome a mix of environmental, systemic, and behavioral forces preventing quality slumber. Modern lifestyles aren't ideal for sleep American sleep culture is marked by contradictions. Anyone who's endured a night of terrible sleep can attest to its importance in cognitive functioning, mood, hunger, and overall health. Yet, many people act in ways that sabotage their hope for a good night's sleep. We stay up later than we should to catch up on work or news or precious free time — what is sometimes called revenge bedtime procrastination. We consume content on our phones so upsetting or attention-grabbing as to prevent our falling asleep, although many of us know by now that screen use an hour before bed results in delayed bedtime and less sleep overall. We settle into bed and realize that late-afternoon coffee or nightcap too close to bedtime has come to collect its vengeance. Some people innately need more sleep than others, and these so-called long sleepers simply cannot find the time in their busy schedules to devote to 10 hours of slumber. Try as we might to have it all, optimizing our waking hours might come at the detriment of our sleep. 'We're trying to have our cake and eat it, too,' Ekirch says. 'The less time we accord to sleep, the more perfect we want it to be for when we do nod off.' Ironically, a population of people with no notable sleep issues has turned sleep into a competitive sport, leveraging mouth tape, expensive mattresses, and sleep trackers like the Oura Ring in pursuit of the perfect night's sleep. This fixation on enhancing sleep may actually do more to promote insomnia than peaceful slumber, experts say. Most disruptions to sleep cannot be blamed on personal choices, though. Parents and other caregivers are among the most sleep-deprived, often contending with their children's inconsistent sleep schedules. And the sleep patterns of shift workers — which account for 20 percent of the US workforce — are dictated by their employers. The ill effects of poor sleep can negatively impact mental health. The opposite is true, too: Mental distress has consequences for sleep. 'Stress, anxiety, weird work schedules,' says Jessi Pettigrew, a clinical social worker who focuses on sleep disorders, 'can lead to the development of sleep disorders like insomnia or circadian rhythm disorders, which basically means being misaligned with your biological sleep schedule because of social reasons.' Environmental and systemic barriers can disrupt sleep Outside of individual behavior, where we live has a role in sleep. Not having the ability to control the temperature in your bedroom because you lack effective heating or air conditioning can be a barrier to sleep, Pettigrew says. If you feel unsafe in your environment, you're less likely to get restful slumber, too, she adds. This tends to impact people with housing insecurity, refugees, and those who are incarcerated. Beyond the bedroom, noise and light pollution from bright street lights and traffic have been shown to interrupt sleep and contribute to insomnia — and those in low-income neighborhoods are more susceptible to these conditions. 'People who live in places with good natural light, green spaces, the ability to control the temperature and light and noise in their environment,' Pettigrew says, 'helps them to sleep better and better regulate their circadian rhythm during the day and sleep at night.' The knock-on effects of altered sleep-wake schedules are profound, ranging from cardiovascular disease and obesity to mood and immune disorders. 'Sleep health disparities disproportionately affect the same populations who suffer from overall health disparities,' Shelgikar says. Those in rural or low-income areas who generally lack access to healthcare, let alone specialized sleep medicine, may continue to suffer from poor sleep, in addition to any number of physical and mental health conditions. Without individualized care, Shelgikar says, the disparities may only widen. How to overcome these sleep obstacles If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you're sleepy can seem trite. Wu suggests identifying the environmental or circumstantial reason you aren't getting restful sleep and doing whatever you can to mitigate it. For those who live in spaces that aren't conducive to sleep — hot bedrooms or the constant wail of sirens all night — there are few things people can do beyond getting a fan or earplugs, Wu says. People with means and flexibility can seek out a doctor specializing in sleep medicine to diagnose potential disorders like insomnia or sleep apnea. If you work odd hours or have a fussy baby, hearing the common advice of keeping your room cool and dark and only retreating to bed when you're sleepy can seem trite. But if your conditions for sleep are pretty good and you still struggle to get shut-eye, the key, according to Wu, may be to not obsess over it as much. 'What you see in people with insomnia is that they're trying too hard,' she says. 'They're tracking their sleep too closely. They are perfectionistic about their sleep hygiene and doing things like going to bed too early or trying to take too many naps, trying to achieve a certain number of hours of sleep, or a certain score on their sleep tracker.' Related The sleep advice no one tells you
Yahoo
25-05-2025
- Health
- Yahoo
‘They won't help me': Sickest patient face insurance denials despite policy fixes
In 2023, Sheldon Ekirch was diagnosed with small fiber neuropathy, which makes her limbs and muscles feel as if they're on fire. Specialists recommended a series of infusions to ease her pain, but her insurer refused to pay for the expensive treatment, which it says is 'not considered medically necessary.' (Ryan M. Kelly for KFF Health News) HENRICO, Virginia — Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder. In 2023, Ekirch was diagnosed with small fiber neuropathy, a condition that makes her limbs and muscles feel as if they're on fire. Now she takes more than a dozen prescriptions to manage chronic pain and other symptoms, including insomnia. 'I don't feel like I am the person I was a year-and-a-half ago,' said Ekirch, who was on the cusp of launching her law career, before getting sick. 'Like, my body isn't my own.' Ekirch said specialists have suggested that a series of infusions made from blood plasma called intravenous immunoglobulin — IVIG, for short — could ease, or potentially eradicate, her near-constant pain. But Ekirch's insurance company has repeatedly denied coverage for the treatment, according to documents provided by the patient. Patients with Ekirch's condition don't always respond to IVIG, but she said she deserves to try it, even though it could cost more than $100,000. 'I'm paying a lot of money for health insurance,' said Ekirch, who pays more than $600 a month in premiums. 'I don't understand why they won't help me, why my life means so little to them.' For patient advocates and health economists, cases like Ekirch's illustrate why prior authorization has become such a chronic pain point for patients and doctors. For 50 years, insurers have employed prior authorization, they say, to reduce wasteful health care spending, prevent unnecessary treatment, and guard against potential harm. The practice differs by insurance company and plan, but the rules often require patients or their doctors to request permission from the patient's health insurance company before proceeding with a drug, treatment, or medical procedure. The insurance industry provides little information about how often prior authorization is used. Transparency requirements established by the federal government to shed light on the use of prior authorization by private insurers haven't been broadly enforced, said Justin Lo, a senior researcher for the Program on Patient and Consumer Protections at KFF, a health information nonprofit that includes KFF Health News. Yet it's widely acknowledged that prior authorization tends to disproportionately impact some of the sickest people who need the most expensive care. And despite bipartisan support to reform the system, as well as recent attempts by health insurance companies to ease the burden for patients and doctors, some tactics have met skepticism. Some insurers' efforts to improve prior authorization practices aren't as helpful as they would seem, said Judson Ivy, CEO of Ensemble Health Partners, a revenue cycle management company. 'When you really dive deep,' he said, these improvements don't seem to touch the services and procedures, such as CT scans, that get caught up in prior authorization so frequently. 'When we started looking into it,' he said, 'it was almost a PR stunt.' When Arman Shahriar's father was diagnosed with follicular lymphoma in 2023, his father's oncologist ordered a whole-body PET scan to determine the cancer's stage. The scan was denied by a company called EviCore by Evernorth, a Cigna subsidiary that makes prior authorization decisions. Shahriar, an internal medicine resident, said he spent hours on the phone with his father's insurer, arguing that the latest medical guidelines supported the scan. The imaging request was eventually approved. But his father's scan was delayed several weeks — and multiple appointments were scheduled, then canceled during the time-consuming process — while the family feared the cancer would continue to spread. EviCore by Evernorth spokesperson Madeline Ziomek wrote in an emailed statement that incomplete clinical information provided by physicians is a leading cause of such denials. The company is 'actively developing new ways to make the submission process simpler and faster for physicians,' Ziomek said. In the meantime, Shahriar, who often struggles to navigate prior authorization for his patients, accused the confusing system of 'artificially creating problems in people's lives' at the wrong time. 'If families with physicians are struggling through this, how do other people navigate it? And the short answer is, they can't,' said Shahriar, who wrote about his father's case in an essay published last year by JAMA Oncology. 'We're kind of reaching a tipping point where we're realizing, collectively, something needs to be done.' The fatal shooting of UnitedHealthcare CEO Brian Thompson on a New York City sidewalk in December prompted an outpouring of grief among those who knew him, but it also became a platform for public outrage about the methods insurance companies use to deny treatment. An Emerson College poll conducted in mid-December found 41% of 18- to 29-year-olds thought the actions of Thompson's killer were at least somewhat acceptable. In a NORC survey from the University of Chicago conducted in December, two-thirds of respondents indicated that insurance company profits, and their denials for health care coverage, contributed 'a great deal/moderate amount' to the killing. Instagram accounts established in support of Luigi Mangione, the 26-year-old Maryland suspect accused of murder and terrorism, have attracted thousands of followers. 'The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry,' Cigna Group CEO David Cordani said during an earnings call on Jan. 30. Cigna is focused on 'making prior authorizations faster and simpler,' he added. The first Trump administration and the Biden administration put forth policies designed to improve prior authorization for some patients by mandating that insurers set up electronic systems and shortening the time companies may take to issue decisions, among other fixes. Hundreds of House Democrats and Republicans signed on to co-sponsor a bill last year that would establish new prior authorization rules for Medicare Advantage plans. In January, Republican congressman Jefferson Van Drew of New Jersey introduced a federal bill to abolish the use of prior authorization altogether. Meanwhile, many states have passed legislation to regulate the use of prior authorization. Some laws require insurers to publish data about prior authorization denials with the intention of making a confusing system more transparent. Reform bills are under consideration by state legislatures in Hawaii and elsewhere. A bill in Virginia approved by the governor March 18 takes effect July 1. Other states, including Texas, have established 'gold card' programs that ease prior authorization requirements for some physicians by allowing doctors with a track record of approvals to bypass the rules. No one from AHIP, an insurance industry lobbying group formerly known as America's Health Insurance Plans, was available to be interviewed on the record about proposed prior authorization legislation for this article. But changes wouldn't guarantee that the most vulnerable patients would be spared from future insurance denials or the complex appeals process set up by insurers. Some doctors and advocates for patients are skeptical that prior authorization can be fixed as long as insurers are accountable to shareholders. Kindyl Boyer, director of advocacy for the nonprofit Infusion Access Foundation, remains hopeful the system can be improved but likened some efforts to playing 'Whac-A-Mole.' Ultimately, insurance companies are 'going to find a different way to make more money,' she said. During the summer of 2023, Ekirch was working full time and preparing to take the bar exam when she noticed numbness and tingling in her arms and legs. Eventually, she started experiencing a burning sensation throughout her body. That fall, a Richmond-area neurologist said her symptoms were consistent with small fiber neuropathy, and, in early 2024, a rheumatologist recommended IVIG to ease her pain. Since then, other specialists, including neurologists at the University of Virginia and Virginia Commonwealth University, have said she may benefit from the same treatment. There's no guarantee it will work. A randomized controlled trial published in 2021 found pain levels in patients who received IVIG weren't significantly different from the placebo group, while an older study found patients responded 'remarkably well.' 'It's hard because I look at my peers from law school and high school — they're having families, excelling in their career, living their life. And most days I am just struggling, just to get out of bed,' said Ekirch, frustrated that Anthem continues to deny her claim. In a prepared statement, Kersha Cartwright, a spokesperson for Anthem's parent company, Elevance Health, said Ekirch's request for IVIG treatment was denied 'because it did not meet the established medical criteria for effectiveness in treating small fiber neuropathy.' On Feb. 17, her treatment was denied by Anthem for the final time. Ekirch said her patient advocate, a nurse who works for Anthem, suggested she reach out to the drug manufacturer about patient charity programs. 'This is absolutely crazy,' Ekirch said. 'This is someone from Anthem telling me to plead with a pharmacy company to give me this drug when Anthem should be covering it.' Her only hope now lies with the Virginia State Corporation Commission Bureau of Insurance, a state agency that resolves prior authorization disputes between patients and health insurance companies. She found out through a Facebook group for patients with small fiber neuropathy that the Bureau of Insurance has overturned an IVIG denial before. In late March, Ekirch was anxiously waiting to hear the agency's decision about her case. 'I don't want to get my hopes up too much, though,' she said. 'I feel like this entire process, I've been let down by it.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.
Yahoo
31-03-2025
- Health
- Yahoo
'They won't help me': Sickest patients face insurance denials despite policy fixes
This is a . Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder. In 2023, Ekirch was diagnosed with small fiber neuropathy, a condition that makes her limbs and muscles feel as if they're on fire. Now she takes more than a dozen prescriptions to manage chronic pain and other symptoms, including insomnia. "I don't feel like I am the person I was a year and a half ago," said Ekirch, who was on the cusp of launching her law career, before getting sick. "Like, my body isn't my own." MORE: UnitedHealthcare CEO shooting opens up 'volcanic' anger toward health insurance agencies Ekirch said specialists have suggested that a series of infusions made from blood plasma called intravenous immunoglobulin -- IVIG, for short -- could ease, or potentially eradicate, her near-constant pain. But Ekirch's insurance company has repeatedly denied coverage for the treatment, according to documents provided by the patient. Patients with Ekirch's condition don't always respond to IVIG, but she said she deserves to try it, even though it could cost more than $100,000. "I'm paying a lot of money for health insurance," said Ekirch, who pays more than $600 a month in premiums. "I don't understand why they won't help me, why my life means so little to them." For patient advocates and health economists, cases like Ekirch's illustrate why prior authorization has become such a chronic pain point for patients and doctors. For 50 years, insurers have employed prior authorization, they say, to reduce wasteful health care spending, prevent unnecessary treatment and guard against potential harm. The practice differs by insurance company and plan, but the rules often require patients or their doctors to request permission from the patient's health insurance company before proceeding with a drug, treatment or medical procedure. The insurance industry provides little information about how often prior authorization is used. Transparency requirements established by the federal government to shed light on the use of prior authorization by private insurers haven't been broadly enforced, said Justin Lo, a senior researcher for the Program on Patient and Consumer Protections at KFF, a health information nonprofit that includes KFF Health News. Yet it's widely acknowledged that prior authorization tends to disproportionately impact some of the sickest people who need the most expensive care. And despite bipartisan support to reform the system, as well as recent attempts by health insurance companies to ease the burden for patients and doctors, some tactics have met skepticism. Some insurers' efforts to improve prior authorization practices aren't as helpful as they would seem, said Judson Ivy, CEO of Ensemble Health Partners, a revenue cycle management company. "When you really dive deep," he said, these improvements don't seem to touch the services and procedures, such as CT scans, that get caught up in prior authorization so frequently. "When we started looking into it," he said, "it was almost a PR stunt." When Arman Shahriar's father was diagnosed with follicular lymphoma in 2023, his father's oncologist ordered a whole-body PET scan to determine the cancer's stage. The scan was denied by a company called EviCore by Evernorth, a Cigna subsidiary that makes prior authorization decisions. Shahriar, an internal medicine resident, said he spent hours on the phone with his father's insurer, arguing that the latest medical guidelines supported the scan. The imaging request was eventually approved. But his father's scan was delayed several weeks -- and multiple appointments were scheduled, then canceled during the time-consuming process -- while the family feared the cancer would continue to spread. EviCore by Evernorth spokesperson Madeline Ziomek wrote in an emailed statement that incomplete clinical information provided by physicians is a leading cause of such denials. The company is "actively developing new ways to make the submission process simpler and faster for physicians," Ziomek said. In the meantime, Shahriar, who often struggles to navigate prior authorization for his patients, accused the confusing system of "artificially creating problems in people's lives" at the wrong time. "If families with physicians are struggling through this, how do other people navigate it? And the short answer is, they can't," said Shahriar, who wrote about his father's case in an essay published last year by JAMA Oncology. "We're kind of reaching a tipping point where we're realizing, collectively, something needs to be done." The fatal shooting of UnitedHealthcare CEO Brian Thompson on a New York City sidewalk in December prompted an outpouring of grief among those who knew him, but it also became a platform for public outrage about the methods insurance companies use to deny treatment. An Emerson College poll conducted in mid-December found 41% of 18- to 29-year-olds thought the actions of Thompson's killer were at least somewhat acceptable. In a NORC survey from the University of Chicago conducted in December, two-thirds of respondents indicated that insurance company profits, and their denials for health care coverage, contributed "a great deal/moderate amount" to the killing. Instagram accounts established in support of Luigi Mangione, the 26-year-old Maryland suspect accused of murder and terrorism, have attracted thousands of followers. "The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry," Cigna Group CEO David Cordani said during an earnings call on Jan. 30. Cigna is focused on "making prior authorizations faster and simpler," he added. The first Trump administration and the Biden administration put forth policies designed to improve prior authorization for some patients by mandating that insurers set up electronic systems and shortening the time companies may take to issue decisions, among other fixes. Hundreds of House Democrats and Republicans signed on to co-sponsor a bill last year that would establish new prior authorization rules for Medicare Advantage plans. In January, Republican congressman Jefferson Van Drew of New Jersey introduced a federal bill to abolish the use of prior authorization altogether. Meanwhile, many states have passed legislation to regulate the use of prior authorization. Some laws require insurers to publish data about prior authorization denials with the intention of making a confusing system more transparent. Reform bills are under consideration by state legislatures in Hawaii, Montana, and elsewhere. A bill in Virginia approved by the governor March 18 takes effect July 1. Other states, including Texas, have established "gold card" programs that ease prior authorization requirements for some physicians by allowing doctors with a track record of approvals to bypass the rules. No one from AHIP, an insurance industry lobbying group formerly known as America's Health Insurance Plans, was available to be interviewed on the record about proposed prior authorization legislation for this article. MORE: Americans are unhappy with the state of health care and insurance But changes wouldn't guarantee that the most vulnerable patients would be spared from future insurance denials or the complex appeals process set up by insurers. Some doctors and advocates for patients are skeptical that prior authorization can be fixed as long as insurers are accountable to shareholders. Kindyl Boyer, director of advocacy for the nonprofit Infusion Access Foundation, remains hopeful the system can be improved but likened some efforts to playing "Whac-A-Mole." Ultimately, insurance companies are "going to find a different way to make more money," she said. In the weeks following Thompson's killing, UnitedHealthcare was trying to refute an onslaught of what it called "highly inaccurate and grossly misleading information" about its practices when another incident landed the company back in the spotlight. On Jan. 7, Elisabeth Potter, a breast reconstruction surgeon in Austin, Texas, posted a video on social media criticizing the company for questioning whether one of her patients who had been diagnosed with breast cancer and was undergoing surgery that day needed to be admitted as an inpatient. The video amassed millions of views. In the days following her post, UnitedHealthcare hired a high-profile law firm to demand a correction and public apology from Potter. In an interview with KFF Health News, Potter would not discuss details about the dispute, but she stood by what she said in her original video. "I told the truth," Potter said. The facts of the incident remain in dispute. But the level of attention it received online illustrates how frustrated and vocal many people have become about insurance company tactics since Thompson's killing, said Matthew Zachary, a former cancer patient and the host of "Out of Patients," a podcast that aims to amplify the experiences of patients. For years, doctors and patients have taken to social media to shame health insurers into approving treatment. But in recent months, Zachary said, "horror stories" about prior authorization shared widely online have created "unified anger." "Most people thought they were alone in the victimization," Zachary said. "Now they know they're not." Data published in January by KFF found that prior authorization is particularly burdensome for patients covered by Medicare Advantage plans. In 2023, virtually all Medicare Advantage enrollees were covered by plans that required prior authorization, while people enrolled in traditional Medicare were much less likely to encounter it, said Jeannie Fuglesten Biniek, an associate director at KFF's Program on Medicare Policy. Furthermore, she said, Medicare Advantage enrollees were more likely to face prior authorization for higher-cost services, including inpatient hospital stays, skilled nursing facility stays, and chemotherapy. But Neil Parikh, national chief medical officer for medical management at UnitedHealthcare, explained prior authorization rules apply to fewer than 2% of the claims the company pays. He added that "99% of the time" UnitedHealthcare members don't need prior authorization or requests are approved "very, very quickly." Recently, he said, a team at UnitedHealthcare was reviewing a prior authorization request for an orthopedic procedure when they discovered the surgeon planned to operate on the wrong side of the patient's body. UnitedHealthcare caught the mistake in time, he recounted. "This is a real-life example of why prior authorization can really help," Parikh said. MORE: Florida woman charged for threatening health insurance company: 'Delay, deny, depose' Even so, he said, UnitedHealthcare aims to make the process less burdensome by removing prior authorization requirements for some services, rendering instant decisions for certain requests, and establishing a national gold card program, among other refinements. Cigna also announced changes designed to improve prior authorization in the months since Thompson's killing. "Brian was an incredible friend and colleague to many, many of us, and we are deeply saddened by his passing," Parikh said. "It's truly a sad occasion." During the summer of 2023, Ekirch was working full time and preparing to take the bar exam when she noticed numbness and tingling in her arms and legs. Eventually, she started experiencing a burning sensation throughout her body. That fall, a Richmond-area neurologist said her symptoms were consistent with small fiber neuropathy, and, in early 2024, a rheumatologist recommended IVIG to ease her pain. Since then, other specialists, including neurologists at the University of Virginia and Virginia Commonwealth University, have said she may benefit from the same treatment. There's no guarantee it will work. A randomized controlled trial published in 2021 found pain levels in patients who received IVIG weren't significantly different from the placebo group, while an older study found patients responded "remarkably well." "It's hard because I look at my peers from law school and high school -- they're having families, excelling in their career, living their life. And most days I am just struggling, just to get out of bed," said Ekirch, frustrated that Anthem continues to deny her claim. In a prepared statement, Kersha Cartwright, a spokesperson for Anthem's parent company, Elevance Health, said Ekirch's request for IVIG treatment was denied "because it did not meet the established medical criteria for effectiveness in treating small fiber neuropathy." On Feb. 17, her treatment was denied by Anthem for the final time. Ekirch said her patient advocate, a nurse who works for Anthem, suggested she reach out to the drug manufacturer about patient charity programs. "This is absolutely crazy," Ekirch said. "This is someone from Anthem telling me to plead with a pharmacy company to give me this drug when Anthem should be covering it." Her only hope now lies with the Virginia State Corporation Commission Bureau of Insurance, a state agency that resolves prior authorization disputes between patients and health insurance companies. She found out through a Facebook group for patients with small fiber neuropathy that the Bureau of Insurance has overturned an IVIG denial before. In late March, Ekirch was anxiously waiting to hear the agency's decision about her case. "I don't want to get my hopes up too much, though," she said. "I feel like this entire process, I've been let down by it." 'They won't help me': Sickest patients face insurance denials despite policy fixes originally appeared on
