I got started on a CGM in the middle of last year and the pre-authorization was completely transparent. My doctor’s office has staff to deal with pre-authorization and after I told my doc I was ready to start, they pretty much instantly did the pre-authorization and the next day the specialty pharmacy was calling me asking me where they should ship it.
HOWEVER my employer switched my insurance company on me on Jan 1 of this year. It was supposed to be exactly the same plan and benefits, just processed by a different company.
Since this batch of sensors only lasts me through Jan 14 I knew I had to start making phone calls to get the pre-authorization through the new insurance.
I call the doctor’s office Jan 2, they say they’ll put it in, should be good next day.
Call the pharmacy Jan 3, no it’s no good.
Call the doctor’s office Jan 3 they ask me more questions about my new insurance and say I ought to be good the next business day.
Call the pharmacy Jan 6, no, it’s no god.
Repeated the cycle above several more times through all of this past week, and each time I’m told they’ll put it in, but the next day the pre-authorization has not gone through.
The doc and the pharmacy tell me, that I cannot call the insurance company directly, I have to work the pre-authorization through the doctor’s office. Is this true? Should I be bugging the insurance company directly?
Should I be bugging the HR/benefits deparment where I work, instead?
If I can’t get a pre-authorization, are there discounts that Dexcom or partners offer to folks who don’t have insurance, or whose insurance is screwed up and refusing to pre-authorize? Or maybe a Dexcom/Dexcom partner knows how to kick-start the broken pre-authorization process?