Changing insurance is every bit as frustrating as changing doctors. My plan, unlike many, does not renew at the turn of the new year. Dutifully I contacted the new insurer to make sure there would not be any problems filling my prescriptions at the pharmacy. If prior authorizations were needed, I wanted to make sure all the paperwork got done in a timely manner.
What a pleasant surprise to hear that none of my meds would need a PA. That turned to disaster when I actually went to the pharmacy and was told that they couldn’t fill the prescription because it did require a pre-auth.
My pharmacist is wonderful and goes above and beyond, fighting for her patients. She phoned my insurance company and was told that they had no record of my calling them. Really? I’d called them three times by that point. I immediately stepped away from the counter and called the insurance company myself. Why on earth would they tell my pharmacist that I’m a liar? Turns out that since I phoned before the policy took effect, their computer would not allow them to document anything. While I was trying to figure out 1) why they had no record of my call, and 2) why they told me I didn’t need a PA if I really did, my pharmacist managed to talk the insurer into a one-time override so that I could continue taking my medicine while they processed the paperwork. Words cannot describe my gratitude.
Fast forward one month. I return to the pharmacy to refill all my prescriptions. They have not heard back from the insurance company so they can’t fill my cimzia. Returning home sans biologic, I emailed my doctor’s office to find out when they sent my insurer the required information. Monday morning, I then contacted my insurer to find out how long they take to process the paperwork. They claim that they haven’t received any information. None. Now, my last insurer tried that, but my doctor’s office was able to show me their fax confirmation which made the insurer magically find the paperwork after all. Not this time. Four hours later the head nurse called me back (I don’t think she’s even in my doctor’s office – hospital systems are so frustrating). She apologized and has no idea why nobody had done the paperwork. It’s not like it should take hours of sifting through chart notes. All they have to do is copy information off the form that was submitted to my last insurance company!
After a long talk with the nurse, it turns out that whoever in my doctor’s office was supposed to take care of the pre-auth paperwork is in trouble. The head nurse promised to fill out my paperwork herself today and fax it to the insurer, as well as phone both the insurance company and the pharmacy to try to grease the wheels and make things happen faster. I’m not sure what good it does to phone the pharmacy because they can’t fill the prescription until the pre-auth shows up (unless I pay cash, which I’ve done with less expensive meds, but I can’t do that with a biologic).
I can understand pre-auth paperwork taking a day or two. If it were my job to process it, I wouldn’t drop everything to turn the paperwork around immediately. I’d probably collect all the requests in a folder and sit down to do them at the end of the day. It wouldn’t take long, though, because I would have the information ready. Think about it. When the doctor first prescribes a biologic, or when a decision is made to switch to a different one, it is assumed that a pre-auth will be required. Insurers don’t ask for your shoe size or other irrelevant info. They want to know what meds have already been tried. They want dates. They want proof that $50 meds don’t work before they pony up thousands of dollars. Patients’ files already have a list of the date each med was started (and stopped). Although it’s probably a hassle to complete paperwork for the insurance companies, it’s not difficult. A high school dropout should be able to do it. What I can’t understand is why, in a full month, nobody in my rheumy’s office managed to get the paperwork done so that I can get my medicine.
Okay, I take that back. New plan. If it were my job to do pre-auth paperwork, when the doctor wrote the prescription, I’d look at the patient’s chart to determine their insurance company, then grab the appropriate form and explain that due to the cost of the med, the insurance company would require extra paperwork. I’d print the patient’s Rx history and task the patient with filling out the PA form.
There are a variety of ways to expedite the paperwork. I don’t think it should take a month. I don’t think it should require the patient to place multiple calls and spend two hours on the phone. I sincerely hope that the head nurse is able to inspire my doctor’s staff to handle things in a more timely manner. If not, I won’t wait until retirement to go elsewhere. I like my doctor, but incompetent staff just might drive me to find a new doctor.