One of the many hoops to jump through when you have diabetes is the need for prior authorization.
Last year I had a lot of problems with my Florida Blue health insurance. I documented a lot of this on Twitter and some issues here on the site. I had so many issues with them as a company and then found out that 100% of my doctors and my wife’s healthcare team were going to stop accepting this MarketPlace plan that I had. So, I only had one choice, changes plans.
I switched to a new plan for a January 1 start date and so far everything had been going great. My premiums are cheap, my deductibles are not a bad cost and all three of the major insulins (Novolog, Humalog, and Apidra) are all covered as a Tier 1 drug and covered at a $75/90 day supply.
The prescription process was simple and easy. Everything was great…… until I needed test strips.
Prior Authorization Confusion
My doctor sent in a script for me to test 6 times a day. Problem is, the insurance will only cover 3 times a day. Not a big deal, I will have my doctor send in a prior authorization. Well, here is where it got interesting.
The mail order pharmacy told me that the prior authorization was needed and they provided me with their fax number. I sent that to my doctor and they sent it in right away. A few days later, I called the pharmacy and they said that the insurance company is still not covering the strips. They said that I had to send in for a prior authorization. I explained I did, but, it was sent to the mail order pharmacy and not to the insurance company. I then requested something to be sent to the insurance company. My doctor called me and said that the insurance company doesn’t have a prescription on file. And, they have no clue what the prior authorization is for.
They didn’t have anything on file because the prescription was sent to the mail order pharmacy. After a few back and forths, the insurance company had a 3-way call with my doctor and my mail order pharmacy to get everything straightened out. I still have to wait another day or 2 until it all processes and I can find out if or when I have an order shipping.
Then, to add to that, once it’s ready to ship, I have to provide a different shipping address, so let’s see how that is handled as well.
The short story of the long story is this. Prior authorizations suck. I know at the end of the day (or week or month), I will get what I need because my doctor’s office will ensure that I do, but having to jump through the hoops sucks. And the 4-5 hours total spent on the phone between the insurance, mail order pharmacy and doctor’s office is even worse. The fact that as a type 1, my insurance is only covering 3 tests a day does not make any sense at all.
I can understand 4 times a day, a test before every meal… breakfast, lunch, dinner, bedtime. But only three?
Do you have any tips, horror stories, success stories about prior authorizations? I’d love to hear them. Please share in a comment below or on Facebook.
Update (02/13/17 2:30 PM
I received a phone call from my doctor this morning stating that they received a confirmation letter from the insurance company that the prior authorization has been accepted. I then received a call from the mail order pharmacy shortly after and they stated that they did not see the update on the acceptance of the prior authorization. However, when they attempted to put the claim through, it accepted the larger amount of strips, 6 per day. Unfortunately, the cost came out to over $100 which is not what the price is supposed to be.
One day I will get these strips.