What the heck is a prior authorization and what can I do about it? Well, I started writing about it -thinking it was going to be short and sweet but then it got longer and longer so here is a 3 part series all about prior authorizations!
This past weekend, work was flowing really well. Then it came to a halt when a woman came in demanding her medication that she said, “I came in last week and you wouldn’t give me my medicine. And even now, its not ready!”
After taking a deep breath, I ask her if she could wait a moment so I can look up her profile and see what the issue is because it was not me that she spoke with. She watches me very closely as I go to the computer and after a moment she starts accusing, “See…see, you wouldn’t give it to me…see!”
I do see, it is a medication for her blood pressure that her insurance company requires a prior authorization for –ugh! And I see a very frustrated woman who just wants her prescribed medication and doesn’t really care about this “prior auth situation.”
Prior authorizations are a pain in the butt for everyone involved.
Explaining prior authorizations to an irritated patient is not only not fun but often difficult because the patient is pissed off and just wants you to shut up and giver her the medication.
This past Sunday followed a typical interaction I have with most of my patient’s with prior authorizations…
I explained that her insurance needs a prior authorization –which means that her insurance requires her doctor’s office to give some information to them before they pay for the medication. This is one way the insurance company controls their expenses.
At this point she launched into a detailed list of why she needs to be on this particular drug.
I followed with –I know (believe me, I know!) and I know it is frustrating. I am not passing the buck but the truth is it is now between your doctor and your insurance company.
At this point she gave me the evil eye and threatened to turn me in and to take her prescription elsewhere…(which may make her feel temporarily better but she will have the same issue at every pharmacy).
The funny part is that we deal with this situation multiple times a day and it usually follows the above steps –So, I thought, how can we nip some of this frustration in the bud? Then it dawned on me that -oh yeah, I have a blog and can write all about prior authorizations! This way it is written down and you can be prepared to efficiently deal with the issue when you hear the dreaded words –prior authorization.
This is part one -read on and really learn the nitty gritty! By all means, if you know any little secrets, you would like to share please leave a comment below…
Please read on and learn about the roadblocks (in the second article of the series!) you will face on your path of getting that damn prior auth and how you can speed up the whole process!