@Carmie wrote:
Most pain meds, injectable drugs, drugs for MS, drugs prescribed by dermatologists, expensive drugs that are name brands that have generic counterparts and drugs used for medical problems, that could also be used for weight control are usually the ones that require preauthorization, as are some RA medications.
Sometimes a drug is covered for some conditions, but not others.
I used to work in the drug preauth department of an insurance company, that was the worst position I have ever had there. I hated that job.
Many drugs are prescribed by physicians that are not medically necessary. Insurance companies only cover medically necessary drugs. The patients are mad as all hello when they are told the drug they were prescribed is not the best drug or the wrong drug for their condition, or not covered or not safe for them to take, due to reactions to other drugs.
Insurance companies have local doctors who are the best in their fields review the claims for drugs that need preauthorization. For example a cardiac specialist would review a drug prescribed by a physician for a heart condition. Many errors are found this way.
Once I,worked on a case where a RX drug was denied preauthorization by a physician who was reviewing drugs for the insurance company I worked for. The drug was prescribed by a doctor who practiced in the same office as the physician who reviewed it. I'll bet those two had words the next day.
If your preauthorization is denied, you can always Appeal it with additional info.
There are phone lines that physicians can call if the drug needs to be taken ASAP and they can talk to a professional in the preauth department.
@Carmie wrote:
Most pain meds, injectable drugs, drugs for MS, drugs prescribed by dermatologists, expensive drugs that are name brands that have generic counterparts and drugs used for medical problems, that could also be used for weight control are usually the ones that require preauthorization, as are some RA medications.
Sometimes a drug is covered for some conditions, but not others.
I used to work in the drug preauth department of an insurance company, that was the worst position I have ever had there. I hated that job.
Many drugs are prescribed by physicians that are not medically necessary. Insurance companies only cover medically necessary drugs. The patients are mad as all hello when they are told the drug they were prescribed is not the best drug or the wrong drug for their condition, or not covered or not safe for them to take, due to reactions to other drugs.
Insurance companies have local doctors who are the best in their fields review the claims for drugs that need preauthorization. For example a cardiac specialist would review a drug prescribed by a physician for a heart condition. Many errors are found this way.
Once I,worked on a case where a RX drug was denied preauthorization by a physician who was reviewing drugs for the insurance company I worked for. The drug was prescribed by a doctor who practiced in the same office as the physician who reviewed it. I'll bet those two had words the next day.
If your preauthorization is denied, you can always Appeal it with additional info.
There are phone lines that physicians can call if the drug needs to be taken ASAP and they can talk to a professional in the preauth department.
@Carmie wrote:
Most pain meds, injectable drugs, drugs for MS, drugs prescribed by dermatologists, expensive drugs that are name brands that have generic counterparts and drugs used for medical problems, that could also be used for weight control are usually the ones that require preauthorization, as are some RA medications.
Sometimes a drug is covered for some conditions, but not others.
I used to work in the drug preauth department of an insurance company, that was the worst position I have ever had there. I hated that job.
Many drugs are prescribed by physicians that are not medically necessary. Insurance companies only cover medically necessary drugs. The patients are mad as all hello when they are told the drug they were prescribed is not the best drug or the wrong drug for their condition, or not covered or not safe for them to take, due to reactions to other drugs.
Insurance companies have local doctors who are the best in their fields review the claims for drugs that need preauthorization. For example a cardiac specialist would review a drug prescribed by a physician for a heart condition. Many errors are found this way.
Once I,worked on a case where a RX drug was denied preauthorization by a physician who was reviewing drugs for the insurance company I worked for. The drug was prescribed by a doctor who practiced in the same office as the physician who reviewed it. I'll bet those two had words the next day.
If your preauthorization is denied, you can always Appeal it with additional info.
There are phone lines that physicians can call if the drug needs to be taken ASAP and they can talk to a professional in the preauth department.
@Carmie My Dr. did all that and they still refused it. I guess the insurance companies are now our Dr.'s
Blogs & Forums
Forums
Blogs
