Re-upping prior authorization tips?

My employer changed insurance providers in Jan 2020 and I had a lot of trouble getting CGM sensors for the first two months of the year while I made phone calls to doctor, insurance company, and pharmacy multiple times each week to figure out how to get them hooked up for prior authorization. It was very frustrating because evidently there was no form for me (the patient) to fill out or track the prior authorization paperwork - it was among those three entities and I could never figure out when the authorization paperwork had passed along the food chain then mysteriously disappeared and I had to make a bunch more phone calls to kick it off again.

I recall that particular prior authorization was good for two years and thus I’ll have to repeat all this in Jan 2022. I am a lucky that due to the shifting the calendars I get to refill a 90-day supply sensors at the end of December 2021 thus won’t have the triple witching of the start of a new calendar year at start of new insurance at the exact same time I need a refill. But is there anything I (the lowly patient) can do in advance to make sure my doctors office, the pharmacy, the insurance company are all in sync?


If and when you get this figured out, I’ll be most interested. It seems no one else in that group has a consequential stake in the outcome. When each of these players think they’ve done their part, they turn their back and move on to other things. They never check back to see that the process actually delivered to the patient.

The classic scenario is when the insurance company faxes a form to the doctor’s office but the doctor’s office does not receive it. No one but the patient senses that something is amiss.

In other words, no one in this process takes “ownership” of the outcome as the patient does. Clear communication with one other person or party can be difficult. When there are four parties to the conversation then the opportunity for a process stall or breakdown goes up exponentially.

Since no one else cares about this outcome like the patient, then your choice falls to either closely managing it or trusting/hoping for the best. I choose close and active management since, in the end, I’ve found it actually takes less total effort than untangling the mess that the other three parties can make if you leave them to their natural course.

I am treated at Joslin diabetes center in Boston and they have staff that deals directly with Dexcom, prescription refills, and insurance matters. Having that service is worth its weight in gold. No matter what the changes, on my side or the prescription provider or the insurance, they are always proactive and ahead of the curve so I have never had any issue or had to waste time making calls or getting delayed service from a provider.

I could use a local endo, within 25 miles of my location, but for me it is worth the 1 3/4 hour 85-mile drive to Joslin for the exquisite, hassle-free services they provide. You may want to check if there is a large diabetic clinic in your area that can do this all for you. This is, of course, not an option for everyone, but if you have that option, I highly recommend it.

1 Like

I go to a large medical center for my diabetes care and I have a nurse practitioner who deals with all of this.
The only time it goes wrong is when I get a new pump or new infusion sets.
It seems like they need 10 different authorizations
So I feel for you.
The one thing taht works for me is to call them every day until they get tired of hearing from you and sort it out