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Insurance Pre-Auth's

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Old 11-14-2007, 07:51 PM   #1
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Join Date: May 2007
Location: WV USA
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whosit HB User
Insurance Pre-Auth's

Does anyone else here have the have the insurance pre-authorize the pain medicine they get? With my insurance every 3 moths I have to have my long acting pain meds approved by my insurance before the will pay for them. they have to fax a form to the doc for him to fill out(takes forever) and he returns it and then they decide to fill it or not. I just went through this because the last one expired and even though from the same insurance for the same meds it took a week and 2 try's from my doc before they paid for it. they then only paid for the 20mg oxy and left the 10mg not approved(still trying to get it approved after 2 weeks without it!). I sub in percocet and my doc said to take 20mg 3 times a day until approved cuz it is still same daily dose and pay myself back when 10mg comes through with them, working so far. My doc said he is almost to the point where he will not deal with pre-auths from my insurance company again because of them jerking around and saying they never got anthing from the doc yet(even though he showed me a copy of the fax he sent them). Anyone else have this problem? What am i to do if he dont want to do the pre-auth next time around? there is nothing i can switch to that does not require pre-auth as well, i asked the insurance myself. How did you deal with this if it happened to you? Calling the insurance does no good for me they tell me they cant do anything and to call the doc. really close to filing a formal complaint with the HR dept of my employer because thats who the insurance is provided by. to beat it all the insurance in hospital employee health insurance! LOL.....thanks just wanted to vent out a little bit and thought someone might be able to relate. thanks for listening


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Old 11-15-2007, 03:31 AM   #2
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Backinthesaddle HB User
Re: Insurance Pre-Auth's

Yup can get a huge bottle of 50mg Ultram but try and get the 200 er's and it takes a small decloration. Makes no sense to me. I noticed that about 2 months ago. Even though my doctor writes a 3 mo script it still has to be approved every single month. Makes no sense to me.

Old 11-15-2007, 02:10 PM   #3
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Boxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB User
Re: Insurance Pre-Auth's

Whosit, my insurance requires a preauth for my breakthrough since it is so expensive. Mine are approved for a year at a time and I just went through a new pre-auth as well. Don't feel bad I waited 2 weeks as well and finally when I heard it was approved, I went to get it and when the pharmacist ran it through, it was denied! It turned out the wrong strength was approved. Now I know my doc calls instead of faxes that way I know from the doc when it was approved and I'm sure he was looking at my chart when he called so I blame the insurance company. It used to be that the particular drug had to be approved then I could get whatever strength my doc gave me. Now if he changes the strengh I have to get a whole new pre-auth. Plus they also denied another breakthrough that I was taking in conjunction and that has really affected my activities. It's pretty sad when the insurance companies are dictating my pain management.


Old 11-15-2007, 02:24 PM   #4
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ms_west HB User
Re: Insurance Pre-Auth's

I had absolutely no idea that some insurances require that you have preauthorization for medications perscribed by a physician. That is terrible!!! Now I have heard everything!!

Old 11-15-2007, 02:25 PM   #5
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Join Date: May 2007
Location: WV USA
Posts: 128
whosit HB User
Re: Insurance Pre-Auth's

that wouldnt be that bad....just once a year? I have to do this every 3 months. BT meds never require pre-auth though so thats good. nothing I can do about it though.....i am pretty much over it though....for 3 months at least!

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