You wonder what a prior authorization is. Many people would do, too. Most patients believe that whatever medicines their doctors prescribe to them, their health insurance should pay for the costs. Furthermore, the pharmacy should fill their prescriptions.
- Defining Prior Authorization
A prior authorization is also known as pre-authorization. It is a requirement that the insurance provider sets. With this requirement, the doctor needs to get approval from the patient’s insurance provider before prescribing a specific medication. This may also apply to patients in need of Compounding Service in MD.
- Why Is Prior Authorization Necessary?
Many insurance providers need prior authorization as a way to lower their costs. In this scenario, the provider will only pay for the benefits if they pre-approve medical care. This is typical for those who need expensive medications.
Even if you get your prescriptions, the insurance provider may still refuse to reimburse the costs without prior authorization.
- When Do You Need a Prior Authorization?
Before setting your prescriptions for a Home Delivery in MD, know which medications you need a PA for. Some of them include:
- Cosmetic medications
- Branded medications that have generic brands available
- Medications that the insurance provider does not cover but the doctor deems medically necessary
- Medications that the provider covers but with dosages higher than the normal levels
- Medications for medical conditions that are not life-threatening
- Getting a Prior Authorization
Below is a general overview of the process:
- Read your policy’s documents to know which of your treatments need a PA.
- For those that need prior authorization, take note of where you need to get the PA forms. Also, know the process of submission. You can find it on your provider’s website or insurance card.
- Your doctor handles the submission of the PA. Work with them.
- Make sure that you double-check the requirements before submission. Everything should follow according to the guidelines.
- After submission, the provider can approve or deny the request. If approved, the PA letter will contain all the rules about the treatment. If denied, you may make an appeal.
You may find the process of getting the PA a long and tedious one. Caplet Pharmacy can assist you with the process. We also offer other pharmacy services. Call us today.