I have reached the age where I spend more time talking to insurance companies than to my own children. I don’t recommend this as a retirement hobby.

Recently, my doctor prescribed a medication. Not just any doctor, mind you, but one who spent years in medical school, survived residency, passed board exams, and has actually met me. He knows my medical history, my allergies, my test results, and the fact that my body occasionally likes to improvise. My doctor spent many years learning medicine in order to prescribe the medication to best treat my problem. My insurance company spent 12 seconds denying it. Guess who won?

Because somewhere, in a building I’ve never seen, an insurance company employee—whose qualifications may include a degree in Spreadsheet Appreciation—looked at my file. This complete stranger reviewed a few lines on a computer screen and concluded my doctor was mistaken. They have never examined me. They’ve never listened to my heart, checked my blood pressure, or asked me to say “Ahhh.” Yet somehow, they know exactly what medication I should and shouldn’t take.

I imagine the conversation between my doctor’s office and the insurance company went something like this:

Doctor: “Based on my years of training and this patient’s medical condition, I recommend this medication.”

Insurance Company: “Sorry, Gary from Claims denied it.”

Doctor: “Gary has a medical degree?”

Insurance Company: “Gary has a dropdown menu.”

Then comes my favorite phrase in the English language: “We require prior authorization.” Prior authorization sounds like you’re applying for permission to invade a small country.

You don’t simply receive medicine anymore. First, your doctor fills out forms proving you actually need the medication he already prescribed. Then someone reviews the forms. Then they request more forms. Then they ask for chart notes, lab results, and possibly your kindergarten report card. Weeks pass. (After all, we wouldn’t want efficiency to break out.) If the insurance company is really lucky, maybe you’ll die before they have to bother with you anymore.

By the time approval (or, in my case, denial) arrives, whatever condition you had has either resolved itself, become chronic—requiring more expensive intervention—or you’ve forgotten why you wanted the medicine in the first place.

Meanwhile, the doctor spends valuable time fighting paperwork instead of treating patients. Entire medical offices now employ people whose primary job appears to be wrestling insurance companies into approving what physicians already prescribed. It’s like hiring hostage negotiators for prescriptions.

Of course, there’s always Step Therapy. If you’re unfamiliar with Step Therapy, allow me to explain. Your doctor prescribes Medication A because studies show it’s the best treatment. The insurance company says, “Before you can have Medication A, we’d like you to fail on Medications B, C, D, and perhaps one we found in an archaeological dig.” Of course, by now, you’re so sick that medication A won’t work, either.

I was a veterinarian for forty-two years, and I can’t imagine telling a client, “Your dog needs this medication, but first we’d like him to try barking less and two cheaper medications that don’t work.”

Imagine applying this logic elsewhere. Your house is on fire. The fire department arrives and says, “Before we use water, we’d like you to try waving a damp napkin at the flames.” Or your mechanic says, “You need new brakes.” The insurance company replies, “Let’s first see how things go without brakes.”

Perhaps the most impressive part is that every denial is accompanied by a reassuring sentence: “This decision was made based on current medical guidelines.” Really? Because my doctor seems to think the current medical guideline is keeping me healthy. Somehow, we’ve created a system where the person with the least contact with the patient has the loudest voice.

I suppose I shouldn’t complain. Insurance companies have saved me from all sorts of dangerous things my doctors wanted me to have. Medication. Tests. Treatment. Feeling better.

Thankfully, someone was brave enough to step in.

If you’ll excuse me now, I need to call my insurance company to ask permission to continue breathing. I have every confidence they’ll place me on hold until they can determine whether air is medically necessary.