Understanding Prior Authorization

What began as a safeguard against unnecessary drug spending has become a significant barrier to patient access.

[radioactivationsystem]

How the hell are insurance companies that never went to medical school authorized to approve or deny medications that a doctor is recommending for their

[ninacarranza]

This is my job. I wish patients saw this video. It takes more than a day to get the PA approved.

[kramer]

I have severe psoriasis and it is the biggest hassle to get approved and fill biologic prescription drugs. I don’t understand why they make this such a hard and lengthy process. The stress that this whole process has put me through has actually made my condition worse. Thank you BCBS for making my life a lot more stressful than it already is.

[sandraalegria]

Patients have no idea what a hard time insurance companies give us to approve a medicine . They want documentation stating you tried a cheaper alternative. In this process of back and forth the patient suffers and believes it's the medical staffs fault. They tell you it's only a phone call or referral from Doctors office to get Authorization it's more than that. It's lengthy and difficult to get Authorization for needed diagnostics tests . It really erks me when insurance companies dictate how to practice Medicine.

[nothingness]

a co-worker had stage 4 lung cancer and was denied treatment. he died during the appeal.

[Bick]

I complained about this on the optumRX YouTube video and they shut off comments. this is how insurance companies handle complaints. its like they dont hear you.

[brandonvolesky]

Doctors and pharmacists that are *literally* experts say I need this medication, but the insurance company has the ability to say no I don't

[Suprnova]

I have to jump through hoops every 6 months for my medication 💊 and it kills me with anxiety everything! Please find a way to speed this up! 🤨

[PS-wghm]

But ER services doesn't need PA approval, some ins carrier will won't accept to process the clm without PA.In that case we can req retro auth with 48hrs from Dos.

[iloveyouyoulovemeify]

prior auths are the bane of my exsistance. prior auths only help the insurance and because of them treatment is delayed. we know the insurance dont care for its patients. a years wait time for approval of biologics when im covered head to toe in psoriasis ..WHY

[minaminari]

This is my job, I am employed to an insurance company and we are the one reviewing and asking questions to the Md, nurses or medical assistants who are submitting PA for the patient. Most of the time, medications that requires PA are those medications that are too expensive and contains opioid that is an addicting substance. This is to avoid abuse, overussage and to reduce cost, no matter what u say, insurance is still a business you know. If the patient really needs the medication, it is being approved most of the time.

[davekimmey]

have to beg for right meds. seems insurance co. isnt bashful about raising premium 100.00 plus per month

[nathanstoltzfus]

Man, so screw the US healthcare system, eh?

[kellycolegio]

Try not sleeping for 16 plus hpurs and headaches. And severe anxiety not to mention all thepersons affected by this it could turn put really bad because of it part is because of it lives are affected . if they realize necessary the person waiting feels terrible in more ways then one. We wait or give up

[ynnethegardn]

I have a question: May I know who approves and denies those prior authorizations of the Ptx? And what are their basis of denying a claims

[Coastingthroughthecosmos]

When they randomly did this to me and I couldn’t pick up my prescription for 2 weeks, I called and asked the insurance agent if it was cheaper for them to approve my usual meds or cover another lengthy grippy sock vacation. I’m not sure if it helped, but I got approval shortly after :)

[kellycolegio]

Difficulty when they tell you contact this person and then it someone who was suppose to submit and you felt good and now that journey must start all ovet again and maybe your doctor is only available certain times etc . pharmacy seems to think uou want more thats not it you just want to feel good and if you dont take you get even more sick .

[JeffMiguel]

Yea it’s been almost 2 weeks and I’m still waiting on my prior authorization. What a joke

[lindawiker]

A medical office run efficiently should have no problem doing this. But using 1 person for 3-4 jobs (receptionist, med assistant, VS taker and lab tech) doesn’t normally create efficiency. Also, there aren’t a lot of insurance companies handing out blank checks to doctors in cahoots with pharmaceutical companies.

[PL-wgco]

Im currently waiting on an approval for a ct scan while i'm in debilitating pain. our healthcare system is completely broken and anyone who disagrees and agrues against universal health care simply hasn't had to deal with it yet.