Authorizations (4/10/2007)
Recently I went to the doctor for kidney stones. I needed to wait a few weeks before I could have a lithotripsy procedure to get rid of the stones. The doctor prescribed Celebrex for pain while I waited because I did not want to use narcotics. When I went to pick up my prescription the pharmacist told me that my insurance company had not approved the prescription and my physician would need to get an authorization number from my insurer. Is this common?
For many common diagnostic or surgical procedures your physician must receive authorization from your health insurer. In fact many physicians who perform procedures bitterly complain about this process because health insurers often are understaffed and do not respond to requests for authorizations quickly. When HealthCue researched your question regarding your prescription we found many insurers are now employing authorization procedures for more expensive brand name prescription drugs. The hope is they will force physicians to use generics instead to avoid the authorization process. The process for prescription authorization often takes a week hours to complete, so in the future if you need a pain reliever, make sure your physician calls before you leave the office so you can get your medication as early as possible.
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medicine authorizations
As a new family physician, I no longer do pre-authorizations for medications. My prescription is my authorization.
Keep in mind that insurance companies make deals with pharmaceutical companies to favor certain drugs in their formulary. I will not allow "side deals" to dictate the standard of care for my patients, so when I get a notice for a pre-authorization, I have the patient call the insurance company and document in the chart that the insurance company is obstructing my patient from receiving the recommended treatment (usually a generic, always first-line therapy).
Florida Family Physician 7/6/2007 10:17:10 AM