Denied, Delayed, Defeated: How Insurance Giants Are Overruling North Carolina Doctors — and Why Kelly Is Fighting to Change That

Susan Merritt of Greensboro spent eleven months fighting her insurance company before she could access the rheumatoid arthritis medication her physician had prescribed. Her doctor, who has treated her for nearly a decade, had determined the drug was medically necessary. Her insurer disagreed — not through any clinical examination, but through a desk review conducted by a contractor hundreds of miles away who had never met her.

Susan's story is not an outlier. It is a pattern — one that is playing out in living rooms, hospital waiting rooms, and urgent care clinics from Asheville to Wilmington, from the Outer Banks to the foothills of the Blue Ridge. North Carolinians are being systematically denied or delayed access to the treatments their own physicians prescribe, and the consequences are measurable in worsened diagnoses, preventable hospitalizations, and lives placed permanently on hold.

Kelly believes this is unacceptable. And Kelly has a plan to stop it.

The Machinery of Denial

Insurance companies have developed a sophisticated infrastructure for rejecting care. Prior authorization — the process by which insurers require physicians to obtain approval before prescribing certain medications or ordering specific procedures — has become one of the most powerful and least visible tools in that infrastructure.

On paper, prior authorization sounds reasonable. In practice, it has become a delay tactic that costs patients their health and costs physicians thousands of administrative hours every year. A 2023 survey by the American Medical Association found that physicians complete an average of 43 prior authorization requests per week. Nearly one in four physicians reported that prior authorization had led to a serious adverse event for a patient in their care — including hospitalizations and, in the most severe cases, permanent disability.

North Carolina physicians are not exempt from this burden. Dr. Marcus Webb, a primary care physician practicing in Durham, describes the process bluntly: "I went to medical school for eight years. I completed a residency. I know my patients. And yet I spend hours every week arguing with someone at an insurance company who has never laid eyes on my patient, defending decisions that should never require a defense."

The step therapy protocol — sometimes called "fail first" — compounds the problem further. Under this approach, insurers require patients to try and fail on cheaper, often less effective medications before approving the treatment their doctor originally recommended. For patients managing chronic conditions, autoimmune disorders, or mental health diagnoses, being forced to cycle through inferior treatments is not merely inconvenient. It can be genuinely dangerous.

The Human Cost Behind the Paperwork

The numbers are significant, but the individual stories are what make the stakes undeniable.

In Fayetteville, a veteran managing post-traumatic stress disorder waited four months for approval of a therapy program his VA-affiliated psychiatrist had prescribed. During that window, he lost his job. His marriage came under severe strain. The treatment was eventually approved — after his congressman's office intervened directly.

A mother in Rocky Mount described spending her lunch breaks every day for six weeks on hold with her insurer's appeals line, trying to secure approval for her daughter's seizure medication. The drug had already been approved by the FDA. Her daughter's neurologist had prescribed it specifically because other medications had failed. The insurer continued to deny it, citing cost as a factor — a consideration that should have no bearing on clinical necessity.

These are not isolated failures of a system working mostly well. They are evidence of a system engineered, in part, to wear patients down until they abandon their claims.

What Kelly Will Fight For

Kelly's healthcare platform addresses the prior authorization crisis directly and without equivocation. The core principle is straightforward: medical decisions belong to patients and their physicians, not to insurance company algorithms or contracted reviewers with financial incentives to deny care.

Strict Prior Authorization Reform. Kelly supports legislation that would require insurers operating in North Carolina to provide real-time authorization decisions for urgent care needs — eliminating the multi-week delays that currently put patients at risk. For non-urgent requests, a firm 72-hour decision window would be mandated, with automatic approval triggered by insurer inaction beyond that deadline.

An End to Step Therapy Abuse. Kelly will push for robust step therapy protections that allow physicians to exempt patients from fail-first protocols when clinical evidence demonstrates that a prescribed treatment is medically appropriate and that inferior alternatives pose a documented risk. No patient should be made to fail before they are allowed to succeed.

Independent External Review. When an insurer denies a claim, patients deserve a genuine appeals process — one that is independent, transparent, and timely. Kelly supports mandatory external review by qualified clinicians who are neither employed by nor financially connected to the insurer making the original determination. The current system, in which insurers frequently review their own denials, is a conflict of interest that must be eliminated.

Transparency and Accountability. Insurance companies operating in North Carolina should be required to publicly report their denial rates, appeal outcomes, and the qualifications of the reviewers making authorization decisions. Sunlight is among the most effective regulators. When insurers know their denial patterns are visible to the public and to state regulators, the incentive structure shifts.

Protecting Patients from Administrative Abandonment. Kelly also supports legislation that would prohibit insurers from requiring patients to restart prior authorization processes when they change plans mid-year — a practice that currently disrupts continuity of care for thousands of North Carolinians managing serious chronic conditions.

A Fight That Is Already Underway

North Carolina is not starting from scratch. Advocates, physicians, and patient rights organizations across the state have been pushing for prior authorization reform for years. Several states have already enacted meaningful protections. The infrastructure for change exists. What has been missing is sustained political will at the level of state leadership.

Kelly is committed to providing exactly that. The relationship between a patient and their physician is among the most intimate and consequential in a person's life. It deserves protection from interference by entities whose financial interests are, structurally, in tension with the delivery of care.

Susan Merritt eventually received her medication. Eleven months late, after dozens of phone calls, two formal appeals, and assistance from a patient advocacy organization she found by chance online. She is managing her condition today. But she is also managing the memory of nearly a year in which the system that was supposed to protect her treated her as a liability instead of a person.

North Carolinians deserve better than that. Kelly is running to deliver it.