What Is the Insurance Prior-Authorization Process?

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.


The Authnet Difference

Luckily, medical centers across the country are working with our team at Authnet in order to make the prior-authorization process much smoother — making life easier on both patients and physicians. We work with hospitals, ambulatory surgical centers, and private practices who are struggling to manage the demands of prior-authorizations for their patients. This makes it so that they are able to get the accurate medications or health services they need as quickly and efficiently as possible. After you call your doctor informing them that you were unable to pick up your medications, they pass this along to our pre-certification specialists where we then:

  • Initiate the prior-authorization request to your insurance company
  • Track your request to approval
  • Provide you with any additional information and appeals
  • Update your records through our secure HIPAA-complaint portal

Our process at Authnet frees up your time, as we handle the prior-authorization process from start to finish. It also saves time for medical professionals so that they can focus less on paperwork and more on caring for patients like you! If your prior-authorization request ends up getting denied, we will follow up with an appeal whenever possible. We have an easy-to-use software and secure portal system for physicians to enter a patient’s information, diagnosis, and fee codes. This will start the prior-authorization process, and our well-trained team of pre-certification specialists will take over managing that process until the very end. If your medical center is ready to say goodbye to prior-authorization paperwork and make the process easier for both you and your patients, contact us today for more information and a free demo of our insurance authorization software. We look forward to working with you!