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    Insurance Companies and the Prior Authorization Maze

    More from our inbox:Elect the U.S. Attorney GeneralFriendship MemoriesA Leadership GapInsurance companies have weaponized a seemingly benign process to protect their profits, and it’s putting patients at risk.To the Editor:Re “‘What’s My Life Worth?’ The Big Business of Denying Medical Care,” by Alexander Stockton (Opinion video, March 14), about prior authorization:Mr. Stockton’s video captures a current snapshot of an important truth about medical insurance in our country and in doing so does a service to all citizens by making them aware of this threat to themselves and their families.The immediate truth is that medical insurance companies are inadequately regulated, monitored and punished for their greed. In their current iteration they are bastions of greed, power and money. They need to be reined in.But there are other truths as well. Some physicians, just like some pharmaceutical companies, are unable to contain their greed and allow avarice to cloud their judgment, compromise their ethics and in some cases cross the line to Medicare fraud or other illegal activity.Medical care in our country is very big business involving billions of dollars. Without proper controls, regulation and monitoring, malfeasance follows. The challenge in such a complex and multifaceted context is how to implement such controls and monitoring without making things worse.Ross A. AbramsJerusalemThe writer, a retired radiation oncologist, is professor emeritus at Rush University Medical Center in Chicago.To the Editor:The Times’s video exploits tragic outcomes and does not mention basic important facts about the limited yet key role of prior authorization in ensuring that patients receive evidence-based, affordable care.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    How to Check in on Your Emotional Well-Being

    We know we should get a physical exam every year; we have annual reviews at work; some couples even do periodic relationship audits. And yet many of us don’t regularly check in with our emotional health — though it is arguably the most important contributor to overall well-being. The New York Times talked to experts […] More

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    My Oldest Friend Is Being Paroled From Prison. Can I Dump Her?

    After supporting an old friend through years of incarceration with letters and shipments of books, a reader wants out, put off by the woman’s lies about her situation.My oldest friend — we met in nursery school and are now in our 60s — is about to be paroled from prison after six years. She pleaded guilty to manslaughter in the death of her sister and to charges of animal cruelty. (Two dogs were also killed.) When she is released, she will have to move in with her parents, not far from me. She still insists that the reports of the police investigation are “all lies.” But it’s clear to me that much of what was reported was true. While she was incarcerated, I wrote her letters and sent her books because I felt sorry for her situation. But now that she is being paroled, I can’t abide the pressure to accept her lies. Any advice on exiting this relationship without causing pain?FRIENDYou have no obligation to remain friends. One of the consequences of bad behavior is that others may choose to cut ties with us — even our oldest friends. Still, I find it hard to believe that the sympathy that fueled your letters and gifts while your friend was in prison has suddenly vanished now that her parole is imminent.If I am wrong, be straight with her. Tell her you no longer want to be in contact. If you are willing to go a bit farther, though, you may be well positioned to offer a great kindness: Explain that her failure to take responsibility for her actions — claiming the reports were “all lies,” for instance — has made your friendship untenable. Encourage her to be honest with herself and others. She may not change her story, but you will have offered a true path to redemption.Now, this approach may cause her pain — as any ending to your long friendship might. But it would seem more consistent with your loyalty during her incarceration than simply disappearing from her life. Still, it’s your decision. I urge you only to think about it.Miguel PorlanMay I Be Excused? I’m Having Trouble Breathing.On Thanksgiving, my family went to dinner at my sister-in-law’s house. As dinner began, our teenage daughter, who has asthma, became short of breath. I suspected it was triggered by house cats, so I took her outside and stayed with her to make sure she was OK. Eventually, I grabbed our plates from the table so we could eat outdoors. When we rejoined the party, our hostess was livid. So, I explained why we had eaten outdoors. She yelled at me and called me rude. I felt so uncomfortable that we left. She has since said she will never invite us to her home again. Was I rude?We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    How Christie and Trump’s Friendship Flourished, Then Deteriorated

    The two men had a relationship that could be genuinely warm, and at other times transactional. Now they are vying for the presidency in open hostility.Their friendship began after an introduction through Donald J. Trump’s sister. It ended nearly 20 years later, when Mr. Trump refused to concede the 2020 election to Joseph R. Biden Jr.In between, Chris Christie, the former governor of New Jersey, and Mr. Trump had a relationship that could be genuinely warm, with chats about politics and current events, and at other times transactional.Mr. Christie gave Mr. Trump a boost by endorsing his 2016 candidacy after ending his own bid for the Republican nomination, and then coached him for debates and led his initial presidential transition team. In return, Mr. Trump passed him over for the roles of vice president and attorney general.Mr. Trump eventually turned back to Mr. Christie for other advice during his term. But by the midway point of the presidency, Mr. Christie seemed content to be on the outside.Their last exchange was in August 2021, according to a person briefed on the matter, when the former president had an aide send Mr. Christie a testy message.Now, they have entered a new chapter: open hostility. Mr. Christie announced his second presidential campaign on Tuesday in New Hampshire, aiming to stop Mr. Trump from a second term in the White House.“I think he’s a coward and I think he’s a puppet of Putin,” Mr. Christie, speaking recently to the conservative radio host Hugh Hewitt, said of the man he once supported.Here’s a look back at how their relationship grew, thrived and then wilted.Casual Acquaintances, Then Presidential RivalsMr. Christie was a United States attorney in New Jersey, where Mr. Trump still had casinos, when the two men first dined together.That May 2002 introduction over dinner came through an intermediary, Maryanne Trump Barry, Mr. Trump’s older sister, who was a federal judge in the state at the time and described Mr. Trump to Mr. Christie as “my little brother.” In Mr. Christie’s 2019 memoir, “Let Me Finish,” he wrote about his first impressions of Mr. Trump, who in two years would begin his run as the star of the reality TV show “The Apprentice.”“Donald was opinionated,” Mr. Christie wrote. “He was bombastic. He was entertaining. He talked about his business with infectious enthusiasm and considerable detail. I came away with the impression that public Donald and the private Donald were pretty much one and the same.”It was soon clear that Mr. Christie could end up as a candidate for governor someday. He won the office in his first attempt, in 2009, two years before Mr. Trump considered running for the White House against President Barack Obama.Mr. Christie won the governorship in 2009 alongside Kim Guadagno, who served as lieutenant governor.Jeff Zelevansky/ReutersBoth men knew each other in the way that prominent people in the New York media market tend to: casually, with paths that periodically crossed.In 2015, both Mr. Christie and Mr. Trump ended up declaring presidential candidacies.Mr. Christie, by then hobbled by the “Bridgegate” political retribution scandal, had nonetheless fashioned a national political brand as a straight-talking candidate.By contrast, some viewed Mr. Trump as a sideshow who would eventually fade, even as he was leading in the polls. At the time, Mr. Trump told Mr. Christie privately that he didn’t expect his campaign to last beyond October 2015.Their relationship began to be tested. Two months after Mr. Trump’s entrance into the race, Mr. Christie told Fox News that the New York businessman didn’t have the “temperament” or experience to be president. Mr. Trump taunted Mr. Christie for being absent from New Jersey, where he was still governor.Ultimately, Mr. Trump overshadowed his newfound rival — and all other rivals — with an endless stream of inflammatory pronouncements, including a proposal to ban Muslims from entering the country.Mr. Christie and Mr. Trump traded barbs after they both entered the race for their party’s presidential nomination.Stephen Crowley/The New York TimesMr. Trump saved his most hostile barbs for candidates other than Mr. Christie. In turn, the governor trained his most aggressive fire on Senator Marco Rubio of Florida during a debate in New Hampshire shortly before the state’s primary, mocking him for a “memorized 25-second speech.”But after staking his candidacy on New Hampshire, Mr. Christie finished a dismal sixth and dropped out of the race.A Key Ally, Up to a PointWhen Mr. Trump won the South Carolina primary, Mr. Christie told allies the writing was on the wall — it was clear Mr. Trump was on track to become the nominee.“I am proud to be here to endorse Donald Trump for president of the United States,” Mr. Christie said at an endorsement event in Florida in February 2016, as astonished reporters watched him praise Mr. Trump’s candidacy. After Senator Jeff Sessions of Alabama, Mr. Christie was one of the first prominent Republicans to endorse Mr. Trump at a time when the party’s leadership was still trying to stop his ascent.Soon, Mr. Christie was a key adviser to Mr. Trump. He was also for a time considered as a potential running mate, but some of Mr. Trump’s advisers, including members of his family, argued against it. (Mr. Christie had also prosecuted the father of Mr. Trump’s son-in-law Jared Kushner years earlier, and Mr. Kushner was opposed to the selection of Mr. Christie.)After Mr. Christie endorsed Mr. Trump, he became a member of Mr. Trump’s inner circle and helped lead his transition to the White House.Cooper Neill for The New York TimesMr. Trump ultimately chose Mike Pence, then the governor of Indiana, who had been introduced to Mr. Trump through Mr. Christie.Mr. Trump tried to keep Mr. Christie on the hook, the former governor wrote in his memoir, insisting in a phone call to Mr. Christie that he hadn’t decided on his running mate yet, even as he made plans to fly Mr. Pence to New York for a news conference.Mr. Christie led Mr. Trump’s preparations for the general-election debates against Hillary Clinton, the Democratic nominee. But after the October 2016 release of a recording in which Mr. Trump described grabbing women by their genitals, Mr. Trump privately griped that Mr. Christie had not more vocally backed him.Mr. Christie also served as the head of his transition team, a job from which he was dismissed shortly after Election Day by Mr. Kushner; Stephen K. Bannon, the chief strategist for Mr. Trump; and Reince Priebus, who would become Mr. Trump’s first White House chief of staff.Behind the Scenes, DistancingMr. Trump asked Mr. Christie to lead a task force on opioids, an issue Mr. Christie had been concerned about as governor. Mr. Christie was also said to be a personal favorite of Mr. Trump’s wife, Melania.As president, Mr. Trump asked Mr. Christie to lead a task force on opioids but passed over Mr. Christie for other roles in his administration.Doug Mills/The New York TimesBut Mr. Trump decided against giving him the job of attorney general, which went to Mr. Sessions. Instead, Mr. Christie has said, the president offered him various roles at different points, including labor secretary and secretary of the Homeland Security Department.Mr. Trump also took a suggestion from Mr. Christie as to who could replace the fired F.B.I. director, James A. Comey. It was Mr. Christie’s lawyer during the Bridgegate scandal, Christopher A. Wray, who was appointed and remains atop the agency. Mr. Trump soon started complaining that Mr. Wray was not doing what he wanted at the agency, and blamed Mr. Christie for a nomination that Mr. Trump had put forward.Mr. Christie took himself out of consideration to succeed John F. Kelly as Mr. Trump’s chief of staff at the end of 2018 after Mr. Trump had offered the job to Mr. Christie. By then, it had become clear that Mr. Trump was cycling through staff members and firing them at a rapid clip.In February 2020, Mr. Trump pardoned a former software chief executive whose clemency Mr. Christie had lobbied for.That year, Mr. Christie wrote Mr. Trump a lengthy memo instructing him how to handle the coronavirus pandemic. It was ignored.Mr. Christie’s relationship with the president grew increasingly strained and later severed after the 2020 presidential election, when Mr. Christie said he advised Mr. Trump to concede to Joseph R. Biden Jr.Al Drago for The New York TimesMr. Trump brought Mr. Christie in for debate preparations once again, and some of his aides faulted Mr. Christie when Mr. Trump’s initial debate against Mr. Biden was disastrous. (Mr. Trump appeared physically unwell at the debate and may have already been affected by the coronavirus; the news of his Covid diagnosis came days later.)When both Mr. Trump and Mr. Christie were hospitalized with serious bouts of Covid shortly after that debate, Mr. Trump called his debate coach at the hospital. “Are you going to say you got it from me?” Mr. Trump asked Mr. Christie, the former governor later recounted in his second book, “Republican Rescue.” They both recovered, but Mr. Christie made clear he thought he should have worn a mask at the prep sessions, angering Mr. Trump.BreakupHours after Election Day ended, when Mr. Trump delivered a speech claiming widespread fraud, Mr. Christie, by then a contributor for ABC News, said on air that Mr. Trump needed to offer proof.In an interview with The New York Times in November 2022, Mr. Christie said he had last spoken with Mr. Trump in December 2020, after the president saw him deride Mr. Trump’s legal team on television. Mr. Christie told him he should concede the election to Mr. Biden and host the president-elect in the White House.“He told me he would never, ever, ever, ever do that,” Mr. Christie said. “And that was the last time we spoke.”In 2021, Mr. Trump described Mr. Christie as an “opportunist” to a reporter. Four months later, he had an aide send Mr. Christie a printout of a tweet by Mr. Christie related to the pardon that he had sought for the former software executive. “Chris,” he wrote, according to the person briefed on it, “How quickly people (some) forget – Best Wishes,” with his signature.Mr. Christie responded cordially, wishing Mr. Trump well.Shane Goldmacher More

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    A ‘Rude and Inaccurate’ Trump at the CNN Town Hall

    More from our inbox:George Santos and Republican Profiles in Cowardice‘Anxious Nation’: A 14-Year-Old Cast Member Speaks OutInformal ConnectionsReporters at St. Anselm College in Manchester, N.H., watched the live CNN town hall in a separate room at the event on Wednesday.Joseph Prezioso/Agence France-Presse — Getty ImagesTo the Editor:Re “Trump Repeats False Election Claims at CNN Event” (news article, May 11):Thank you for your thorough and factual reporting on Wednesday’s CNN town hall with former President Donald Trump. You summarized each of the mischaracterizations, exaggerations and untruths spoken by Mr. Trump in your Fact Check and related articles.Unfortunately, it’s likely that many right-leaning voters drawn to watch the town hall will not be inclined to read them. Likewise, the studio audience for the show, evidently chosen to represent Trump supporters, won’t realize or doesn’t care about the damage his rude and inaccurate statements do to the body politic of our country.CNN made a grievous mistake following through with its plan to air the program after the verdict in the E. Jean Carroll case was announced on Tuesday.Mr. Trump benefited greatly from the undiscriminating and constant coverage of his untruths in the 2016 election. It’s time for responsible print and television journalists to pull the plug and refuse to provide a platform for Mr. Trump’s lies and vulgarity.Jim LinsellTraverse City, Mich.To the Editor:I think it was appropriate for CNN to invite Donald Trump to appear at its town hall. The former president, after all, is the leading candidate for the presidential nomination of one of our two major political parties.I don’t subscribe to the philosophy held by some of the louder voices in the media that “I may disagree with what you say, but I’ll defend to the death my right to prevent you from saying it.”If there was a problem with Wednesday night’s broadcast it was the format. Specifically, making the host, Kaitlan Collins, function as both the facilitator of the event’s question-and-answer framework and the fact checker for Mr. Trump’s responses. Being effective in one of those roles is challenging enough; doing both is impossible.John E. StaffordRye, N.Y.To the Editor:Re “The MAGA King, Back in Prime Time” (Opinion, May 10):Michelle Cottle, in her defense of CNN’s decision to air a town hall with Donald Trump, doesn’t mention an important point.The problem is not just that the network is giving a platform to a man who tried to overthrow our democratic process. CNN is also giving him more airtime than his challengers, which is what got us into this mess in the first place.From the moment Donald Trump descended the escalator to announce his candidacy in 2015, the cable networks gave him unprecedented free coverage — cementing his status as a serious candidate in a way no other presidential hopeful had ever been treated.The election is more than a year away, and already Mr. Trump is manipulating the media, pitting Fox against CNN and grabbing an hour’s worth of prime time.To Ms. Cottle’s most important question: No, we have learned nothing.Betty J. CotterShannock, R.I.George Santos and Republican Profiles in CowardiceRepresentative George Santos, leaving federal court in Central Islip, N.Y., after his arraignment on Wednesday.Johnny Milano for The New York TimesTo the Editor:Re “Santos Is Indicted as Inquiry Claims 3 Finance Schemes” (front page, May 11):It was satisfying to read of George Santos being charged, especially after enduring months of his smug defiance. Mr. Santos doesn’t represent New York’s Third District; he represents the worst type of person — one who lies to get ahead, one who preys upon the less fortunate, one who cheats the system.That such a fraud should help decide the laws of our nation is appalling. Mr. Santos doesn’t serve his constituents; he serves himself. And in his refusal to admit to his alleged fraud, he serves as the epitome of political cowardice.Not surprisingly, House Republican leaders have shown their own political cowardice in winking at Mr. Santos’s bad behavior, even as he’s taken to task for it, in an effort to maintain their tight majority.I applaud House Republicans who have called for Mr. Santos’s resignation and encourage more to follow suit. In “Profiles in Courage,” John F. Kennedy wrote, “Not all Senators would agree — but few would deny that the desire to be re-elected exercises a strong brake on independent courage.”Would that more members of Congress could depress the accelerator.Gary J. WhiteheadNorwood, N.J.To the Editor:Re “Santos Pushed Campaign Money Abuse Past the Usual Line,” by David Firestone (Opinion, May 11):Mr. Firestone writes that George Santos’s alleged scheme to funnel money to himself through a 501(c)(4) organization was “spectacularly dumb.” In fact, it was brilliant and would have succeeded if he hadn’t made the mistake of actually getting elected to Congress.Frauds are discovered because the victim eventually figures out what is going on. In the case of misappropriated election contributions, contributors virtually never check whether the contributions actually went to the campaign, and indeed they didn’t here. If he had not been elected, The New York Times would have never checked his assertions, contributors would not have complained and prosecutors would have never investigated.If Mr. Santos had lost, as he may have intended, he could have walked away with the money.James FogelBronxThe writer is a former chief of the Frauds Bureau of the Manhattan district attorney’s office and a former judge of the New York City Criminal Court.‘Anxious Nation’: A 14-Year-Old Cast Member Speaks OutKameron Johnson as seen in the documentary “Anxious Nation.”Anxious Nation/Area 23a/Lasega FilmsTo the Editor:Re “Anxious Nation” (movie review, May 5):I’m a 14-year-old cast member of “Anxious Nation.” This film is much more than talking to “a handful of struggling teenagers and some of their parents.” Over four years, we made a brave decision to share our struggles with mental health to help others who are struggling too.I found your use of the word “tantrums” especially upsetting. The raw videos you see are real panic attacks. Not “tantrums.” Panic attacks that kids as young as 3 are having.I know this. That is me. Parents don’t realize or understand it.The courage displayed throughout the film is extraordinary and deserves to be acknowledged. It’ll give families a tool to learn from. It’ll give kids my age someone to relate to, and that’s so dear to my heart. I didn’t have that growing up.You are entitled to your opinion of “Anxious Nation,” but to steer away families who really need this film feels wrong and irresponsible.Families need this. My generation is in a crisis.Seveann MortonCardiff, Calif.Informal ConnectionsThe Brookdale Park dog owners have become real friends beyond the park, going to dinner, movies and comedy shows together.Bryan Anselm for The New York TimesTo the Editor:Re “They Know Your Face, Maybe Not Your Name” (The New Old Age, Science Times, April 25):I worked for a company I loved for 13 years, and the last year I was there, I stopped every morning at a Dunkin’ Donuts on the way to the office. On my final day of work, I went there as usual and told them of the occasion.As the Dunkin’ staff all wished me well, I was on the verge of tears (and simultaneously laughing about crying) as I carried the coffee to my car. It made me truly appreciate the importance of those informal connections we encounter as part of our daily lives.Amy S. RichOrange, Conn. More