It may contract with a pharmacy benefits management company to process prior authorization requests for certain prescription drugs or specialty drugs. What is a prior authorization.
Prior authorization health insurance can be complicated especially when it comes to prior authorization also referred to as pre approval pre authorization and pre certification.
How to get a prior authorization for a prescription. If a prescription needs prior authorization the pharmacy will notify the healthcare provider who will give the necessary information to the insurance company. To find out if a specific treatment needs prior authorization start by asking your doctor. Call your insurance company and see if they need you to fill out any forms.
How long does it take to get prior authorization for a prescription. These factors include things like how the prior auth is submitted call fax etc when it is submitted the length of the review process whether additional. If your prescription requires a prior authorization the pharmacy will notify your healthcare provider who will provide the necessary information to your insurance company.
A prior authorization pa sometimes referred to as a pre authorization is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine medical device or procedure. The speed of a prior authorization can vary drastically from minutes to days depending on a number of factors. We ve provided the following resources to help you understand anthem s prior authorization process and obtain authorization for your patients when it s required.
Then double check directly with your insurer. This process of deciding by analyzing the conditions will on average take up to two days. Without this prior approval your health insurance provider may not pay for your medication or operation leaving you with the bill instead.
Call your physician and ensure they have received a call from the pharmacy. Your insurer will then decide whether or not to cover your medicine and you should hear back from your pharmacist about their decision within two days. The insurance company will then decide whether or not to cover the specific medications.
If you need to speak with a human in an effort to get your prior authorization request approved the human most likely to help you is the clinical reviewer at the benefits management company. Checking on a prescription is even easier. Look up the drug in the insurance plan s formulary the plan s approved drug list.
Prior authorization is a requirement that your physician obtains approval from your health care provider before prescribing a specific medication for you or to performing a particular operation. Ask the physician or his staff how long it will take them to fill out the necessary forms. How to get prior authorization after the fact.