Medication pre authorization
TL;DR I feel my doc’s office is mostly accountable for my medication pre auth timeline doubling in length
Not really looking for advice, just venting here because I’m slightly annoyed by my pre auth experience, mostly on my doctor’s office behalf, surprisingly (instead of insurance). Just gonna jump right in with my timeline.
5/31 Med prescribed by doctor, sent in to pharmacy 6/1 Called my pharmacy to check pick up status, pharmacy said the Rx was sent back to doc because it needs pre authorization from insurance 6/4 I go to doc for unrelated issue, mentioned that my pharmacy sent back the rx for pre-auth, doc did not know/see that yet and I was told it would be sent right away 6/7 I’m not sure which of these events took place first: 1. Doc sent pre-auth sent to my health insurance (HI), unsure exact time 2. I called HI to inquire on status, HI said they don’t handle my “pharmacy benefits” and are unable to see the status (at this time I didn’t know rx’s do not go to my HI, or who handled my pharmacy benefits, that it was a separate insurance, etc). I assume that the pre auth was sent to the right place (PI) since HI also said that they hadn’t received a pre auth anyways and I have gotten other prescriptions very recently so my doc office must have it on file (later confirmed this with doc office) 6/10 Found out what org my pharmacy benefits are through, I’ll refer to as pharmacy insurance (PI) although I’m not sure that org is technically insurance (member ID/group # same as regular HI insurance…) 6/12 called PI to check status of pre auth, they never received it, they gave me the fax number to send pre auth to, to relay to my doc 6/12 (immediately after) called doc office and informed them of above info, pre auth was sent and process has finally actually started (called PI few hours later to verify and was told that avg turn around time is 15 days)
Ugh I’m just frustrated that it took 12 days from date of written Rx to finally get the process started, after having to make several phone calls myself to actually get the ball rolling, and may take another 15 days for a decision (if even approved). Who knows how much more delayed this would be had I not been persistent, you know? I DO understand that any process takes time, hence why I was courteous in waiting a few days in between phone calls. I’m wondering if it is common practice for docs to wait for a pre auth request instead of doing it at the time of writing the rx? If it matters, it is a schedule 4 controlled substance and my doc gave me the impression that she has written this rx a lot, so I feel like she should have known it would need a pre auth in the first place Edit: typed and posted from my phone, formatting got messed up, I’m so sorry
submitted by /u/salmonslappin
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