Neurology off the Hill sees record engagement: ‘It’s a group effort’
September 23, 2025
Neurology off the Hill had a record number of participants this year, speaking up for telehealth flexibilities and prior authorization reform.
August marked Congress’s summer recess—a time when lawmakers return to their home states and connect with constituents. It also marked one of the AAN’s signature advocacy events: Neurology off the Hill, which saw a record of more than 150 participants this year.
This event, the summer counterpart to Neurology on the Hill, empowers passionate neurologists all over the US to form relationships with their representatives and staff while offering insights, stories, and actionable steps for change.
The AAN’s leaders determine a set of priority issues for Neurology off the Hill—major topics in neurology practices and institutions across the country, for which representatives’ support could mean a great deal. This year’s priority issues were telehealth flexibilities and prior authorization reform.
“Telehealth is a lifeline to our patients—it’s not just a convenience,” said Neurology off the Hill participant Alvin P. Singh, MD. “And in terms of prior authorization, there are so many unnecessary obstacles in the way that impact both patients and providers. So we need to make that very clear to our lawmakers.”
Telehealth flexibilities
Critical telehealth flexibilities from the COVID-19 public health emergency have been a game-changer for countless people with neurological conditions, especially those who would otherwise struggle to access care due to long wait times, rural locations, and other barriers. While Congress has extended these flexibilities multiple times, a permanent fix is necessary to protect access to care and allow patients to schedule follow-up appointments.
Neurology off the Hill participants brought their own experiences on how telehealth has helped their patients—and asked their representatives to co-sponsor the CONNECT for Health Act (/). This bill would make certain telehealth flexibilities permanent for patients covered by Medicare. It would remove site of service and geographic restrictions, protect access to audio-only appointments, and require the Centers for Medicare & Medicaid Services (CMS) to report back on how telehealth has impacted patient access and quality of care.
Neurologists across the country have stories about how telehealth has transformed patient care—and Neurology off the Hill participants are no exception.
“We brought examples to the table of how our patients had barriers to getting the care they need so desperately—and how telehealth can preserve continuity of care and be a lifeline to the people who need it,” Singh said. “It can be helpful for my patients to be in their own home and have the ability to speak with their family members.”
One such patient was a man whose mobility issues made it difficult to make it to appointments. Compounding the problem was that his daughter, who worked two jobs, couldn’t afford to take time off work to travel to his in-person appointments.
“Telehealth gave us an option where she could take 30 minutes off from work to attend this meeting and give valuable insights into how her dad is doing, and that helps move care forward,” Singh said.
These stories help personify policy issues, making it clear how people are affected by things like telehealth flexibilities. Singh describes seeing staffers’ entire body language change as they realize how important the topic is and lean forward to scribble notes.
“They’re seeing so many people who have so many needs,” Singh said. “Our stories are the bridge from their constituents to the patients we care for. Together, we move policy forward.”
Prior authorization reform
Prior authorization—the process through which a clinician must get approval from their patient’s insurance before delivering a medication or service—is a heavy burden for neurologists and their patients. More than 75% of neurologists report prior authorization causes changes to prescriptions or requests for service, and over 49% of business administrators say organizations spend up to 40 hours a week on prior authorization activities.
CMS implemented a rule last year that put guardrails around prior authorization and allowed for electronic approvals. To ensure these guardrails stay in place, Congress must act to codify them into statute. Neurology off the Hill participants asked their legislators to co-sponsor the Improving Seniors’ Timely Access to Care Act (/). This bill codifies the guardrails from CMS, and it opens the door for potential instant approvals for certain services that are regularly approved—helping countless patients access the care they need, when they need it.
Neurology off the Hill participant Meeryo Choe, MD, FAAN, found herself with no shortage of stories about this issue, and how it can frustrate physicians and harm patients.
One such patient was a boy struggling with migraines, which could last an exhausting four to five days and cause visual symptoms like blurriness. Complicating the problem was the boy’s other conditions, which prevented him from using some common migraine treatments. After trying some different treatment options, Choe decided to prescribe a newer medication.
“This was actually the second time that I’d asked, but we’d exhausted a lot of other options,” Choe said. “So myself and his parent had to go up against his insurance—and he had excellent insurance, which his parent paid quite a bit for and thought it would be easy to get this covered. Well, it was denied.”
Choe went to investigate and found that despite the detailed information she had included in the request—the medications the patient had already tried, the reasons he couldn’t use other common treatments—the insurance company had written that no such justification was included.
It was time to do something physicians are very familiar with: Appeal a denied prior authorization claim. Choe spent half an hour on the phone, only to be directed to download and fill out an appeals form, get it signed by the patient, mail it in, and wait seven days for the insurance company to review the appeal. To make the process even more frustrating, the boy was currently dealing with one of his migraines.
Choe and the boy’s parent had to call the insurance company together. This time, she was told she could call for a peer-to-peer appeal—though, as the representative couldn’t give the number while the parent was on the call, Choe resorted to tracking it down online herself. One phone call later, the company confirmed that the justification had been submitted and the patient could finally pick up his medication—which would have been prohibitively expensive without insurance.
She and one of her students, who had come with her to the meeting to get an early experience with advocacy, told this story to a stunned aide. “Dr. Choe has hundreds of patients she takes care of, and this is just one story,” she recalls the student saying.
“It’s not unusual that we have to go through prior authorization to get one of these newer medications approved for our patients,” Choe said. “And they’ve already tried things—it’s been months that they’ve been suffering from their conditions. For this instance, it was migraine, but I have colleagues who go through the same thing for patients who have epilepsy.”
Be an advocate for yourself and your patients
Stay up to date on AAN advocacy opportunities by reading Capitol Hill Report, a biweekly newsletter that’s published online and emailed to US members. You can also join the Political Outreach for Neurological Support (PONS) network to get exclusive information on the AAN's federal, regulatory, and state advocacy, plus access to quarterly webinars. AAN members can apply for events like Neurology on the Hill, which takes place in February; contact their representatives through the Advocacy Action Center; and more.
Thousands of AAN members are involved in neurology advocacy—and that matters.
“If we’re not at the table, we’re on the menu,” Singh said. “I think it’s important for people to understand that the decisions made in Washington directly influence our clinic realities and the realities of the patients we care for. We are the voices for our patients, and our collective voices mean a lot more than just one person speaking up alone. It’s a group effort.”