‘We could have had him longer’: Georgia mother says insurance approvals cost her time with dying son

ATLANTA, Ga. (Atlanta News First) — Kathy Lemoine said her son, Andrew, was diagnosed with terminal Stage 4 colorectal cancer at 29, and that the family repeatedly ran into insurance prior authorization requirements for procedures, medications and supportive care.

Lemoine said one of the biggest fights was over intravenous nutrition, known as total parenteral nutrition, or TPN, which she believed could have helped Andrew maintain strength in his final months.

“I begged, and I begged, and I begged. They finally gave him the nutrition. But by that point, it was too late,” Lemoine said. “He was not going to get rid of it, but he could have lived a bit longer. We could have had him longer.”

The issue is drawing new attention as advocates and providers warn that automation can speed up denials while slowing down care. Liz Coyle, executive director of Georgia Watch, said the growing use of automated systems can move decisions further from a patient’s doctors.

“A robot, an AI bot, is making those life-and-death decisions. That’s just outrageous,” Coyle said.

Nationally, physicians report widespread problems with prior authorization, according to the American Medical Association. An AMA survey found 95% of doctors said prior authorization delayed necessary care, and 26% said those delays resulted in a serious adverse event, including hospitalization, permanent disability or death.

Georgia lawmakers recently passed Senate Bill 444, sponsored by Sen. Kay Kirkpatrick, limiting insurers from using artificial intelligence or software as the sole basis for denying coverage and prohibiting those systems from overriding professional medical judgment. The law is set to take effect in 2027.

Anna Adams of the Georgia Hospital Association said patients are often surprised to learn that an agreed-upon care plan with a physician is only the first step, because insurers still decide whether to cover services.

She said hospitals and providers report insurers can slow care “through prior authorizations and unnecessary requests for information,” and that delays can worsen conditions by keeping patients from timely medication or diagnostic testing.

“Ultimately, it ends up being more expensive for both the patient and the insurer,” Adams said. She also said automation can generate quick denials based on procedure codes or keywords, forcing hospitals to submit more documentation and extending delays.

Adams said some patients struggle to find recourse because the Georgia insurance commissioner does not have jurisdiction over every plan.

“Patients may not know whether their plan is an ERISA plan, whether it’s fully self-insured,” she said, noting that can shift complaints to federal oversight.

U.S. Sen. Jon Ossoff has increased scrutiny on prior authorization practices. This spring, he launched an investigation after hearing from Georgia patients who said their care was delayed or denied.

Ossoff sent a letter to Centers for Medicare and Medicaid Services Administrator Mehmet Oz seeking information about insurers’ prior authorization practices and cited reports from Georgians of months-long waits, denials of life-saving medications and insurer decisions that overrode physicians’ recommendations.

Georgia’s insurance regulator said it enforces prior authorization laws for private health insurance plans under O.C.G.A. 33-46-20 through 33-46-32. The Georgia Office of the Commissioner of Insurance and Safety Fire said in a statement that it has not seen an unusual uptick in prior authorization complaints. The office encouraged consumers who believe laws were violated to file a complaint at OCI.ga.gov or call 404-656-2070, according to its statement.