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American Medical Association

Many times, your treating medical provider may want to prescribe you a medication or order diagnostic studies such as MRI or CT scan that requires prior-approval by your insurance. You may be on a medication for years and your new insurance would not cover unless your provider submit rational for prescribing that medication. 


Keep in mind, although your provider may want you to take a certain medication or get a certain test or procedure, there is no guarantee that your insurance would approve when it comes to prior authorization. The prior-authorization process is often complex. Sometimes patients believe all that must be done is a phone call. That is not always the case. Many times, the prior-authorization number on back of your insurance care is not for the actual department that decides to deny or approve a prior-authorization request. That phone call includes answering numerous questions. The process may include additional paperwork. The delay in prior authorization is inherent in the process.


Many benefits plan have an online portal to submit prior authorization. Still, that process involves significant time to complete. If your provider’s office has many prior authorizations to do, then you can understand how your specific case can’t be handled immediately. 


Prior-authorization delays care, adds cost to care, creates stress for both your provider and you and interferes with the doctor-patient relationship. 


Patients to be proactive and 

  1. Verify with your new insurance that they will cover your medications before switching insurance.

  2. Contact your political representative to simplify the process, if there must be one at all.

  3. Notify your insurance company how prior authorization has affected you.

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