If you need a prior authorization for a medicine we prescribed (prior authorizations can only be done for prescriptions or refills we have previously approved), we request your patience and partnership. Insurances require prior authorization for several medications, even when you have been stable on them. Although your insurance has access to your information and why we have prescribed a certain medication, they still require us to complete a form with your most recent diagnosis, medications we have tried in the past, and why we are prescribing the specific medication in this instance. This usually takes about an hour. That is time that is taken away from our patient care. This is how you can help:
- Make sure your insurance is up to date. A change in insurance (even an update to the same on you’ve had) may require a new physician authorization.
- If you have not had a visit within 2 weeks of a prior authorization request, you may need another visit before we can submit a new prior authorization.
- A denied prior authorization is never a denial from us, regardless of what the insurance company says. It means your insurance is not satisfied with our reason and requires more information. Even then, they may deny the prior authorization. If this happens, you may have to pay out of pocket or contact the insurance company.
- Please tell us during your visit if you have filled your prescriptions (you can view which medications we have listed for you on your patient portal on your patient summary, usually within a week of your visit). We do get a report, but it is not always the most up to date.
- Below we have Physician Authorization Forms from Medicare, CVS Caremark, ExpressScripts and US Script, the 4 most common prescription fillers for insurance companies. If you fill out the appropriate form with your name and insurance information and bring it in, that will really help us!
Your cooperation is greatly appreciated and will make for a smoother process. Thank you for letting us be your partner in optimal well-being!