77M patient with history of laboratory confirmed hypogonadism on long standing testosterone transdermally called office to request standard refill of testosterone. Somehow/someone accidentally linked “erectile dysfunction” as the indication triggering a LONG PROCESS of PAs from medicare, doctor personally wrote letter on patients behalf stating the case, denials, 2nd request-> denial, 3rd request -> court hearing which is now pending in Mid April
My recent experience with UHC Medicare Advantage prior authorization showed serious communication issues and delay issues on a knee procedure that was so obviously needed that it should have not required prior authorization, particularly with the MRI showing a clear indication for surgery.
I am a Medical Assistant in Dermatology, been working for the same company for 7 years this August. I took over medication prior authorizations about 4 years ago. In my experience medication authorizations are lengthy and delay patient care. We can be the best, but the delay in response on medication determinations makes us look bad.
I needed a CT of the chest because of some pulmonary nodules found on a previous CT 4 years ago. I had to go get a chest X-ray before they would approve a chest CT. That was a waste of my time and money.
A patient was controlling their high blood pressure with medication. The insurance company changed which prescription it would cover, but the patient had a previous bad reaction to that specific drug.
I have a transgender patient who has completed 2 of 3 planned surgeries for a phalloplasty, but the 3rd and final procedure has been hung up in the approval process for weeks and the original surgeon is threatening to cancel his planned procedure.