WWYD? I have NEVER heard of this before: Dr visit related.

I just want to a doctor, mainly to refill a prescription. After the whole visit was over an assistant came in and informed me that their office does not do Prior Authorizations (basically a receptionist called the number provided, or fill sour some forms and faxes over to my insurance.) Which is actually what my insurance need in order to cover this medicine!

They offered me to work with their own pharmacy to get a good price. That pharmacy is really not very convenient: it's very far from my house!

Have you ever heard of a doctor's office who refuses to do Prior Authorization?

Basically, I just waisted my time and money to go to this doctor FOR NOTHING!

WWYD? I have NEVER heard of this before: Dr visit related.

It's becoming more and more common because the prior authorizations are absolutely NOTHING just "a receptionist calling in" or a "form being filled out". It used to be that easy. Now, insurance companies are making it more and more difficult. Also, are you sure it was a prior authorization and not a "tier" override. I will NEVER do a tier override again because after SIX hours for ONE patient for ONE medication the insurance still refused the override (Medicare part d and this happened with multiple patients this year).

ETA - I've been doing this for well over a decade, so it's not like I'm new to getting these auths and inexperience was why it took that long, lol. Just wanted to clarify that.

All that said, them wanting you to use "their" pharmacy is shady. That would throw me off. We would recommend pharmacies, but never have one of our own (like Walmart or Costco because they have cheaper pricing).

Message edited 8/20/2015 8:54:30 PM.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

Not sure what Tier override is, but mine just required a Prior Authorization. I am just really pissed, because the only reason I went was to get this prescription. They should tell this ALL new patients before making an appointment: I would gone to another practice that does not consider it beneath them to take a small extra step for their patients! They had no problem taking my co-pay and collecting money from my issuance!

WWYD? I have NEVER heard of this before: Dr visit related.

I would try to get my copay back maybe. I mean, you make an appt to get a refill and then you're told they can't do it anymore? That would aggravate me. Plus. So many times u just need a refill buy they make u come in, see the doc for 5 min, they ask how you are, then you spend a copay. It can be such nonsense.

Message edited 8/20/2015 9:10:19 PM.

WWYD? I have NEVER heard of this before: Dr visit related.

It really isn't nonesense for a doctor to see a patient periodically for refills of medications, there are legitimate reasons why they need to see you, even if it is "just five minutes". I guess my opinion would depend on he medication it is, for example, if it was a birth control med that you prefer over another almost identical generic (or lesser known brand) and have no medical reason why you can't take the insurance preferred drug, then I side with the office.... But, if it's for a Parkinson's medication where there is no equivalent, or a migraine medication where you have actually tried every other medication that is insurance preferred with no benefit, then they should have done it for you. But again, it's all circumstantial.

Tier override is a new trick the insurance companies are using this year (never experienced it before in 14 years). Essentially drugs that used to be either formulary or that in years past would require a prior authorization, they are making formulary with no prior authorization required but tier 4, meaning a copay of like $300 for a $350 drug. Then they say, oh your doctor can try to get a tier override.... And then we call, quite literally spend hours and days working on this, and still it does not get approved for override.

I think the point of doctors refusing to do prior authorizations is a valid one, especially for a small practice, it takes up lots of man hours that often are just not available. Also, I think the hope is that patients complain to their insurance providers and their benefits administrators, and congressional representatives to hopefully bring about some change.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

Try target without insurance.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

I work for an outpatient provider and while I don't deal with the insurance side of things, I know that they have had to put a great deal of this stuff back onto the patients/families.

It has become too time consuming to deal with, especially in a place I work that has such a high volume of patients.

There are so many negative changes going on with these insurance companies, especially reimbursement rate-wise.

Like only being able to Bill $3-$5.00 a session.

I get people's frustrations with expecting the medical pracitce to handle it, but at the same time, many people don't understand all that goes on behind the scenes.

With us we also work with a population that really needs a case manager or someone else to step in and help.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

If we don't start rising up against the insurance machine, it will only get worse.

I work for a health care agency and we have to fight with the insurance company to pay us for our services. Takes hours to get authorizations. And the insurance companies love that because they have all the time and resources they need, we don't. The odds are ever in their favor.

We were recently denied authorization for services for a patient. I personally went through the appeal process and won. I can't tell you the insanity we went through, and i'm a supervisor and it took hours of legwork and getting forms signed by the patient to allow US to represent HER in the appeal (I had never even heard of this, must be new schtick the companies are coming up with every day!!!!)

Re: WWYD? I have NEVER heard of this before: Dr visit related.

WWYD? I have NEVER heard of this before: Dr visit related.

I totally understand that the paperwork for insurance takes a lot of time but that is part of the business of being in the medical field and having a practice. I would never go to a doctor who would tell me that he or she would not fill out the necessary forms to help his or her patient get the medication that he or she thinks is necessary. It is one thing if the dr thinks the genetic or the medication that the insurance company wants to give is appropriate but why would a good dr want his or her patients to not get (or have to try the other things if they know that it is not appropriate) the appropriate medication even if it means spending time on paperwork.

I am not in the medical field but in a field that there are a lot of times that what needs to be done takes a lot longer than I would like. But I do it because I care about my clients.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

Re: WWYD? I have NEVER heard of this before: Dr visit related.

Policies are in place for a reason though.

It's been my experience that they aren't put into place to annoy patients.

ETA: and it is also your choice if you don't want to attend a certain place.

Message edited 8/21/2015 1:14:11 PM.