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re: The Prior Authorization Process for Medicine
Posted on 3/7/24 at 9:38 am to LSUFanHouston
Posted on 3/7/24 at 9:38 am to LSUFanHouston
What I don’t get is how an insurance company can refuse to cover a medication that your doctor believes you need. And I don’t understand prior authorization. If your doctor wrote you a prescription then it stands to reason he believes you need it. Why does the insurance company need additional info from the doctor? Maybe I don’t understand what prior authorization is but I do know it’s very inconvenient for the patient.
2
Posted on 3/7/24 at 9:41 am to EST
Some of the decisions are insane.
A recent example from my household is that insurance will only cover three months of Protonix (gastro meds for acid reflux, amongst other things) for an entire year. Doctor’s instructions are to use every day.
But they have no problems approving some other types of drugs of questionable need.
A recent example from my household is that insurance will only cover three months of Protonix (gastro meds for acid reflux, amongst other things) for an entire year. Doctor’s instructions are to use every day.
But they have no problems approving some other types of drugs of questionable need.
Posted on 3/7/24 at 10:08 am to EST
quote:
how an insurance company can refuse to cover a medication that your doctor believes you need.
because it's privatized "for profit" healthcare...
oh wait, you aren't seriously thinking insurance companies work for the benefit of the people that pay for coverage, are you? insurance companies, as publicly traded companies, HAVE to work for the benefit of their shareholders and HAVE to strive to make a profit... one of the biggest ways to do that is to have very restrictive formularies and reject tons of claims...
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