Put simply, a prior-authorization is a process used by certain health insurance companies to determine whether or not they will cover a prescribed medication or health services. This restriction is placed in order to help both your doctor and your insurance provider feel comfortable that your medications and/or services are medically appropriate for your care. At Authnet, we know that as a patient, the prior-authorization process can be frustrating. Here is a real-world example of the prior authorization process, what it entails, and how Authnet can help make this process go more smoothly for both medical centers and patients.
Real World Example
Say you go into the doctor to discuss some flu-like symptoms you have been having. You are then prescribed medication and head over to your pharmacy to pick up your medication. Upon arrival, the pharmacist proceeds to tell you that your prescription won’t go through your insurance company without prior-authorization. Now, not only does your stomach hurt, but now you have a headache just from trying to get your medications. In most cases, your pharmacist will then contact your doctor and let them know that your medication requires prior authorization. Your doctor will then contact your insurance company and fill out the appropriate forms needed for approval. Sometimes, the insurance company may need you to fill out additional paperwork. This process can often take days to complete, even weeks — and no one wants to have to wait for relief when they are feeling under the weather. The reason for this is because many medical centers only have one or two staff members who are in charge of filing all of their paperwork — which can add up quickly. That is where our team and state-of-the-art software at Authnet comes into play.