#prior authorization

[abearinthewoods]

r/nursing is brutal right now regarding the shot ceo.

[acidsimp]

X93.XXXA is not on UnitedHealthcare's Prior authorization List, and is not covered. Have you tried any conservative therapy such as Phycian directed home therapy, OTC meds and/or physical therapy? You can also just file an appeal with-

[rannadylin]

Petition to abolish the prior authorization process. It's the epitome of what's wrong with the American health care system.

(The link is a gift article so you can access it without the paywall.)

[fraye-complex]

Doctor said I could have Androgel

Insurance said lemme think about it

Fuckers

[ophilosoraptoro]

Whistleblower Exposes Health Insurers' Most Evil Scheme

[spooniestrong]

View this post on Instagram

A post shared by Dr. Glaucomflecken (@docglauc)

Fight back against insurance companies! Watch this!

[vizthedatum]

My doctors finally confirmed an infection that I thought I had today (well the test results came in yesterday, and I messaged three of my doctors and they all interpreted it).

Anyway (I know my life is a lot! Chronic health issues are A LOT), I just posted this on facebook:

—

I am about to start a 10 day course of antibiotics for a serious bacterial infection (not a UTI or STI - pls DM to ask) so I will be more immunocompromised than usual.

I am not contagious (it’s not airborne) but the antibiotic course will weaken me even though it’s treating me.

I have suspected I’ve had this underlying infection for about two months now, and honestly… because of my chronic pain and living with pain/disability for so long, I have just… dealt with it.

What choice do I have? I am simply now trying to be more and more assertive to my doctors. I have been trying to tell them.

I am tired.

I’m actually having a higher energy day today than normal and have been catching up on chores. I even got flu and covid vaccinated today!

But this post is to say:

I’m not gonna cancel the social plans I have this week but I will be masking so I don’t get sick with something else (like the strain of covid that’s not accounted for by the latest vaccine), and I would appreciate if you would mask around me too (and have clean, washed hands) since my immune system is not doing that great right now.

—

While writing this message, my pharmacy just called: my antibiotic is not covered by my insurance and costs over 4000 dollars (to which I said WTF I LITERALLY TESTED POSITIVE), so I will be in yet another prior auth hell (my bladder meds are still in holdup).

(And also they told me that my T vial is only good for 28 days and they have to give me a new one for next week’s injection)

[theorgantrail]

Insurance: Healthcare Workers' Perspective (i.e why it sucks)

1. Why Doctors Don't Carry Your Insurance

This was one of the most surprising things to learn when I started working in a dr's office. Insurance sucks just as much for providers as it does for the patients. (The only upside is we have a separate hotline for calling).

Doctors have to pay (quite a lot of money $$$ btw) to register as providers with insurance. Each individual company (BCBS, USAA, Kaiser, etc) requires a fee, and often will have different processes for registration. This process is not instantaneous, either, but can take anywhere up to 2 years.

That is why many younger/newer providers will often only carry a couple insurances. So the more insurances a provider carries, the more they fought and paid for accessibility for their patients.

2. Prior Authorization

“Physicians spend an enormous amount of time fighting these prior authorization rejections to get patients the therapies that they need,”

-Jack Resneck Jr., MD

What doctors wish patients knew about prior authorization

One major problem in healthcare, which one of our admins talks about in the insurance section, is prior authorization.

I have personally worked in healthcare on and off for about 3 years. At one point, I was a receptionist for a busy ENT clinic, where I helped file medical and insurance paperwork and talked to just about e v e r y insurance company there is the US.

One of the most common (and incredibly frustrating) forms was prior auth, and everyone involved absolutely hates this form. The doctor, the MA's, the patient, the insurance workers you call, etc. Often, we have to call back and forth over a period of weeks to even months to get a patient a single medication that is very often necessary for living.

Mind you, this again takes a lot of precious time. Dr. Resneck went on to say that, "We physicians often find ourselves fighting over and over and over through a series of appeals to get the patient the medication or the test or the treatment that they need," which I can attest is absolutely true! Talk about incredibly dangerous for continuity for care and health of the patient!

On top of how busy the clinic and physicians are, these authorizations and appeals often go to the support healthcare workers, like receptionists or MA's, to handle.

Most often was a medication that was simply being refilled by a new doctor, or occasionally the exact same doctor (the patients window of insurance viability had just lapsed)! A patient could have been on a medication for YEARS and suddenly the insurance would be dragging their feet. And they won't talk to patients, the point-blank will only discuss and haggle with physicians and their representatives (ie. ME).

There is lot more to this subject, but unfortunately, I have other homework to get to.

Did either of these surprise you?

[lucysweatslove]

Today’s “US healthcare and insurance system sucks” rant is: prior authorizations!

New and expensive drug? I understand even if I don’t always agree. Experimental treatment where risks vs benefits really aren’t well established? Also understood. But standard of care that can be hugely lifesaving? Creating such a hassle that patients DIE during the PA process? Like wtf?

Not a new article (it’s like 7 months old), but always rage-inducing for me.

[ivebeenmade]

I already knew that 'prior authorisation' policies had gotten out of hand, but it actually hit me personally today.

The doctor bumped up my Lyrica, a non-narcotic pain management medication, and when I called the pharmacy to ask if it would be ready to get tomorrow, they explained that it had hit a PA. The reason?

My doctor wants me to be taking 100mg in the morning, 50 in the afternoon, and 100 at bedtime. She prescribed this in 50mg capsules. The insurance "does not allow" for more than 3 pills of this med per patient per day.

Does Not Allow. As if an insurer understands the needs of a patient, or should ever have a say over a medical professional.

This means the doc has to send 2 different prescriptions in. One total 50mg capsule for the midday dose, two total capsules per day for the morning and night.

So I have to organise and remember two different pills for the same med every day; taking one bottle everywhere with me so I can take it around lunch, keeping the other home for my pill organiser.

What a giant pain in the ass. What a totally weird restriction.

What's even worse is that I literally just took my last full dose today, and this med can cause pretty nasty withdrawal symptoms.

I have 2 more 50mg doses I am going to space out for the next 2 days- *just in case* asking them to rewrite scripts in a way my insurance approves of doesn't get done in the hours the primary care office and the pharmacy are both open tomorrow.

[sand-and-spice]

"Issues with Health Insurance Companies, Explained by Doctors - Wall Street Journal"

[franklinpep]

Prior Authorization and Referral

Ever wondered about the difference between prior authorization and a referral? How do these processes impact your healthcare experience? If you're looking for clarity on these important topics, you're in the right place! Dive into this informative article on prior authorization vs. referral to understand how each plays a role in your healthcare journey. Don’t miss out on this essential information!

[agshealthrevenuecycle]

With evolving payer requirements, navigating the prior authorization landscape requires adaptation, efficiency, and clear communication. Discover strategies to build strong partnerships with insurers, create standardized processes, and leverage technology and automation in our latest blog post. Plus, get insights into changes healthcare professionals need to be aware of as it relates to the future of the payer and regulatory landscape. https://www.agshealth.com/blog/mastering-prior-authorizations-adapt-to-payer-changes-and-thrive/

[havegaysex]

I hate doctors so much

I hate doctors so much. 11 days ago I asked my psychiatrist to send a prior authorization to Medicaid because I cannot afford $50 copay. This dipshit sent it to my primary insurance which was already covering it (didn't need the prior auth) and leaving me a $50 copay that I can't pay. Im disabled and I can't work. I need Medicaid to cover all my prescriptions. I have a very small supply ADHD meds left bc I strategically skip doses on rest days where I don't need to get anything done but if I didn't plan for situations like this with incompetent doctors I would be completely out of medication for nearly 3 weeks. The pharmacy told me before I even said that message on June 6th that they sent the request for prior authorization to my doctor. I'm getting a new psychiatrist after this. This is my most important medication, without my straterra and not a safe driver, I can't get anything done around the house I struggle to leave on time.its more important I take it every night before a day I need to leave my house for anything than for me to take my bipolar meds every day.