Kayla’s Story
I work in a medical practice and have been working on prior authorizations for medications for over five years. With the exception of a few insurance companies being proficient and easy to work with, a majority of insurance companies make it extremely difficult to obtain an approval for medications for patients in a timely manner…
Dr. Allan’s Story
My pediatric patient had tried multiple different medications to manage his ADHD symptoms. We were finally able to find a successful treatment that allowed him to be functional and safe from the moment he woke up. However, a few months into treatment, his insurance suddenly decided that a prior authorization was necessary to continue the…
Erica’s Story
My pharmacy said my medication needed a prior authorization so they notified my primary care physician. My physician said I shouldn’t need this since I’ve been on this medication for years. After a week went by and I didn’t hear anything back I contacted the pharmacy again and they said the prior authorization was needed…
Dr. Ted’s Story
I have a patient, a 35 year old male with documented obstructive sleep apnea. I did a physical exam to confirm it and he has been observed by a family member who is a nurse that he stops breathing at night. I tried getting a full polysomniagram done but insurance denied it. They told me first I had to perform a home sleep test. We did that and I tried to order a polysomniagram again and was told we needed a Prior Auth…
Dr. Emily’s Story
I have a patient who is post op from a cesarean section. She had a complication of a wound abscess. She was hospitalized and had interventional radiology procedures to treat the abscess.
She is two weeks out from that complication. She return to clinic with concerns of a new infection around her incision. She was seen in our office. Given her previous abscess that required drainage via a procedure, I wanted to get another CT scan of her pelvis. We ordered the scan through our outpatient radiology clinic in our hospital (where she had previous imaging).
Dr. Gary’s Story
A 50 y/o established patient came in to my private practice for her annual exam. I found a lump in her breast on physical exam that was suspicious. I referred her to our general surgeon who performed a lumpectomy and the biopsy showed malignancy. I referred her to an oncologist.
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