Prior Authorization


#1

Like so many diabetics over the years, I am currently struggling with getting the amount of test strips I need approved by my insurance company. I know, this is an old issue to most of you, and everyone's had to go through it; but today, I learned a little bit about the process for getting my test strips approved, and I must vent about it before I throw my diabetes meter across the room.

In trying to lower my A1C (and being a little paranoid about lows), I've been testing, on average, about 15 times a day. That's 450 test strips a month. It's also about 450 calls that I've had to make to my doctor, pharmacy, and insurance company. My insurance company only covers 200 test strips per month. Here's how my initial phone call went. Note the confusion in my questions about this ridiculous process.

Me: "Hi, my doctor has prescribed me 450 test strips a month, but my insurance only covers 200. How do I get the 450 approved through the insurance?"

Insurance Co: "You need to get prior authorization."

Me: "Okay. How do I go about doing that?"

Insurance Co: "You have to ask your doctor to call the prior authorization number and have him or her tell us that you need 450 test strips a month."

Me: "But, she wrote 450 test strips on my prescription."

Insurance Co: "Yes, but she needs to call and give prior authorization for that."

Me: "So basically she needs to call to say that she wasn't lying on the original prescription?"

Insurance Co: "Yes." (Apparently, this customer service rep had gotten this question before and has lost all sense of humor.)

Me: "I know this situation isn't your fault, but the insurance company does understand that I need these to live, right?"

The conversation kind of lagged from there. I got the authorization phone number. My doctor has called the number, and the insurance company has sent over the prior authorization questionnaire. (What do you think is on that questionnaire? I think it should be one question: Did you, in fact, prescribe your patient 450 test strips because she's actually trying to be diligent about her sugars and would prefer not to be on dialysis at some point in her life? Circle yes or no.)

The kicker is when I called the insurance company back today, more confusion ensued:

Me: "Yes, I'm just trying to check on the status of a prior authorization request."

Insurance Co: "Yes, we did send that paperwork to your doctor. When she sends it back, someone will look it over and decided whether or not to approve it........."

Me: "Wait." I then apologized for cutting her off. "Someone approves it? As in, someone could also disapprove it?"

Insurance Co: "Yes, you can keep checking back. It only takes someone 24 hours to approve or disapprove something."

"Great," I thought, because it only took about a month to get this whole thing to progress far enough for this phone call. I didn't argue this time. (I had a very long drive from Jersey to Boston yesterday and did not have the energy.)

What is wrong with these insurance companies? If they would just cover most of the cost of the continuous glucose monitor supplies (at this point, I'm willing to pay for the actual device on my own), I wouldn't need 450 test strips a month.

Here's hoping that they'll approve something that is essential to my overall health. Being that their sole purpose is to provide HEALTH insurance. I guess that's only for people who are already healthy.


#2

Sorry your having such a hard time.

In my opinion insurance companies only speak one language…cheap.