Millions of patients in the U.S. continue to face significant hurdles with prior authorization, a process requiring insurer preapproval for medical care, despite promises of reform from insurance companies. Sheldon Ekirch, a 31-year-old from Henrico, Virginia, battled Anthem for two years to cover $10,000-per-infusion IVIG treatment for small-fiber neuropathy, spending $90,000 out-of-pocket before an external review overturned the denial in February. Similarly, Payton Herres and Anna Hocum faced denials for essential medications and treatments, highlighting the ongoing struggles. While some insurers like Aetna, Humana, and UnitedHealthcare have cited specific changes, many others have failed to provide details, leaving physicians and patient advocates pessimistic about meaningful reform and the industry's commitment to patient well-being over profit.