I am confused by the direction of your frustration . . .
Making sure that the prescript
ion pre-authorization process gets started is generally up to the patient. Reading the drug/prescript
ion formulary specific to your particular insurance plan, what is covered, what is not covered. Every insurance policy has its own contractural obligations based on the insurance underwriting.
If you have recently changed insurance policies, it is up to you to get the paperwork to your physician or to notify the clinic benefits coordinator to get the approval process started. Medical records, diagnostic ICD-9 or ICD-10 codes, and physician rationale for sustained need.
A typical physician office has dozens of different medical insurance plans that it contracts with to provide services to plan members. Each policy may have its own unique exclusions or limitations. It is incumbent on the patient to know the contract provisions of his/her medical insurance plan and any authorization requirements for pharmaceuticals, imaging, procedures, or inpatient admission status.
Like you, the opiate prescript
ions I receive require preauthorization (as the dose exceeds the CDC guidelines). I keep note on my calendar of the dates of service/time period authorized with a reminder to begin the authorization process at least 4-6 weeks before the current authorization expires. I have been fortunate to receive full year/12 month authorization periods.
If you are in dire straits, most insurance plans have expediated approval processes to fast-track urgent needs for pharmacy prescript
ions, CT and MRI imaging studies, and surgical procedures.
Once you have authorization for your patches, keep copy of the approval notice with your personal records. Make a note in your calendar at least 4-6 weeks before the authorization expires to remind you to get a new authorization started if you need continuation of the patches.
More and more, monitoring prescript
ion due dates and formulary lists is the onus of the patient.
For the immediate need, you can ask your physician to write a prescript
ion for one box of patches and pay for these out of pocket (not submitted to insurance for reimbursement). This would tie you over while the approval paperwork is processed.
Hopefully, this is a one-time hiccup for you.
Pituitary failure, wide-spread endocrine dysfunction
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)
Post Edited ((Seashell)) : 8/13/2018 11:40:33 AM (GMT-6)