NEW REPORT: Georgians Report Insurance Companies Are Denying or Delaying Care Doctors Say They Need

Click hereto read Sen. Ossoff's new report on insurance companies denying or delaying Georgians care their doctors say they need

Atlanta, Ga. - A new report from U.S. Senator Jon Ossoff reveals insurance companies are denying or delaying care Georgians' doctors say they need.

Today, Sen. Ossoff released a new report that details how Georgians are suffering delays or denials of medically necessary health care due to issues with "prior authorization," where an insurance company can deny care even if doctors prescribe patients the treatment and say they need it.

The report includes dozens of reports from Georgia patients, who have reported that prior authorization issues with their insurance companies have resulted in delays and denials of medically necessary health care, leading, in some cases to untreated life-threatening conditions, and/or severe financial hardship.

In January, Sen. Ossoff launched an investigation into the impacts of rising health care costs and cuts to health care services, and in June, Sen. Ossoff urged Georgians to share stories of insurance companies denying or delaying medically necessary health care.

"No American should be delayed or denied needed health care. It is unacceptable that Americans, who are paying record premiums to insurers making record profits in the world's richest country, are nevertheless denied medically necessary care," Sen. Ossoff said. "I will continue exposing these practices and working to ban insurance companies from denying or delaying needed health care."

Georgia cancer patients and their family members have reported to the Senator's staff that their medically necessary cancer treatments have been delayed and denied by their insurance companies. As detailed in the report:

• Kathy Lemoine, based in Lawrenceville, is a mother whose son, Andrew, was diagnosed at 29 years old with colon cancer and passed away six months later, shortly after turning 30. Ms. Lemoine reported that the process of watching her son deteriorate was "unbearable." "Many parts of his treatment required prior authorization. And the one thing you don't have with cancer is time to waste," Ms. Lemoine observed. During his initial hospital stay after having a colostomy bag, Andrew was given and subsequently prescribed certain medications. However, Ms. Lemoine was unable to initially pick up Andrew's medication because his prescriptions required prior authorization, meaning their insurance company had not yet approved them. Ms. Lemoine reports, "stopping these medications would have been life threatening for Andrew." Ms. Lemoine was forced to pay out-of-pocket for the medications. During his chemotherapy, Andrew also suffered from extreme nausea and struggled to eat, and his mother requested that he receive intravenous nutrients. However, his insurance refused to pay for the nutrient solution reportedly because Andrew was still being seen on an outpatient basis. Ms. Lemoine reported that for close to three months, the insurance company still refused to approve the solution, despite her many requests. Even when Andrew transitioned to inpatient care after being unable to eat, the insurance company still would not approve the solution for another month. Ms. Lemoine reports that during those two months Andrew lost 70 pounds and was constantly nauseated. Ms. Lemoine notes, "Andrew would still be gone today because his cancer was so advanced, but he may have lived longer and suffered so much less if he had proper nutrition."

Georgia parents have reported to the Senator's staff that, even when their child's doctor prescribes a specific medication or treatment, insurance companies have delayed or denied medically necessary care, placing their children at unnecessary risk of harm or injury. As detailed in the report:

• Julia McCool, based in Buford, is a mother who has a two-year-old son. When he was about one year old, he was wheezing and having difficulty breathing, and Mrs. McCool took him to the ER where he was diagnosed with RSV and was prescribed an albuterol inhaler to force his airways open if he had an asthma attack. About one month later, her son started wheezing again, and Mrs. McCool took him back to the ER where she reported his doctors prescribed Flovent, a preventive medication that would lessen the risk of asthma attacks and wheezing over time. However, a day later, after leaving the hospital, Mrs. McCool had not heard from her pharmacy that the prescription had been filled. She called, only to learn that the medication required a prior authorization, which she said had not been approved. When she called her insurance company, they told her to "get the hospital to prescribe something else." Even though the company eventually approved the medication, Mrs. McCool reported that she was "desperate" and "making calls to get this done" while her son was sick and still wheezing:"My child was prescribed his doctor's first choice medication, and that should be what he gets. My insurance company should not decide what medication my child takes."

Georgia patients, including those with disabilities, have reported to the Senator's staff that delays and denials of their medically necessary health care have led to untreated conditions, resulting in extreme pain, risk of injury, dangerous symptoms, financial stress, and even suicide. As detailed in the report:

• Lindsay Morrison, based in Fayetteville, learned that there was a problem with the discs in her spine in April 2025. She was diagnosed by an orthopedist with degenerative disc disease of the spine and was told she needed an immediate surgery to address one of the discs in her neck. Her doctor told her that if she had the surgery within 15 days, she would be guaranteed not to have nerve issues. The surgery was scheduled for mid-May, and then the day before the surgery, Ms. Morrison said she received a call from her doctor informing her that the insurance company would not cover the surgery because she had not first gone to physical therapy to address the issue. For four months, between May and August, Ms. Morrison said that her insurance company continued to delay and deny her access to the surgery, requiring her to "jump through hoops" to get the approval, including physical therapy sessions and obtaining a third-party opinion from a different doctor. Within two weeks of physical therapy, Ms. Morrison said she was in so much pain that she had to quit therapy and could not even tie her own shoes, take her dog outside, walk around the block, or participate in her daughter's birthday party. Ms. Morrison finally received approval for the surgery from her insurance company in August. She told the Senator's office that she now must take daily medication to deal with nerve issues that have emerged in her arm due to the delay in getting the surgery. "Every aspect of my life was affected," she reports. "Any faith I had in religion or people was completely gone after this experience."

A Johns Hopkins study found that the practice of prior authorization, where patients must seek approval from their insurance company before receiving care, was "associated with disease exacerbation, preventable hospitalization, prolonged hospital stay, and lower rates of disease-free survival."

According to KFF, virtually all seniors enrolled in Medicare Advantage must obtain prior authorization for some services, and in 2024 over four million of these requests were denied.

Additionally, KFF also found that of the approximately 85 million Affordable Care Act (ACA) in-network denied claims in 2024, less than 1% were appealed, forcing patients either to pay for services out-of-pocket, despite having "coverage," or forgoing care - solely because of decisions made by insurance companies.

Sen. Ossoff continues to work to ban insurance companies from denying or delaying needed health care.

Last month, Senate Republicans blocked a Senate resolution cosponsored by Sen. Ossoff to stop the Trump Administration from allowing artificial intelligence to improperly deny seniors' needed health care.

In June, during the Senate's vote series, Sen. Ossoff offered an amendment to prevent insurance companies from denying or delaying needed health care, but Senate Republicans blocked Sen. Ossoff's amendment. This followed Senate Republicans blocking Sen. Ossoff's amendment during a Senate budget debate in April.

In April, Sen. Ossoff launched an inquiry with CMS Administrator Dr. Mehmet Oz about insurance practices that lead to denied claims and delayed health care that patients need.

Click here to read Sen. Ossoff's new report: Georgians' Health at Risk: Insurance Companies Denying Necessary Health Care.

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