Despite insurers pledging to ease prior authorization burdens, a 70-year-old with primary immunodeficiency missed critical doses of her immune globulin therapy after switching Medicare Advantage plans — landing her in the ER and later the hospital. Her insurer, Humana, denied coverage multiple times before reversing decisions only after exhausting appeals. The case spotlights how industry promises haven't translated into real relief for patients.
Margaret Hvatum, a 70-year-old part-time professor with primary immunodeficiency, depends on a weekly immune globulin infusion (Hizentra) to keep her immune system functioning. When she switched Medicare Advantage plans at the start of the year, her new insurer, Humana, denied prior authorization for the drug — even though she'd been on it for over a decade. The result: missed doses, a UTI-triggered ER visit, an overnight hospital stay, and eventually a stroke — all with coverage initially denied.
This comes despite major insurers, including Humana, signing a pledge to reduce prior authorization burdens and honor existing approvals for 90 days when patients switch plans. Humana clarified that the pledge applies only to medical services, not prescription drugs — a loophole that left Hvatum without her medication. Each denial was ultimately reversed, but only after she filed exhausting appeals.
By the Numbers:
Why it matters: Hvatum's story reflects a systemic problem: prior authorization denials are common, appeals are exhausting, and industry pledges to reform have real loopholes. With only a fraction of patients appealing denials — despite high overturn rates — many may be quietly going without care they need.
