Many insurance companies have a list of medications that they sometimes will pay for, sometimes not. These are medications that require "pre-authorization" from your insurance company. In other words, your doctor must try to persuade your insurance company to cover these medications, in writing, on a special insurance company form.

WHAT DOES PRE-AUTHORIZATION REQUIRE OF YOUR DOCTOR?

Very few insurance companies will use your doctor’s notes and records to decide when they will or will not cover the cost of medicines. They all could, and a few are starting to to streamline the process. Most require that your doctor fill out and submit for their review a special "medication pre-authorization form".  Worse, some require the doctor to call the insurance company to answer their questions about the medication. The information your insurance company wants on forms is often detailed. They want your doctor or someone in your doctor’s office to list all the other medications that you have tried, to describe what the results of these medications were, to describe your medical condition and diagnosis, and finally to explain why the medication that your doctor wants to prescribe is necessary. After your doctor does all this, by copying information from his or her notes onto your insurance company’s special form, there is STILL a good chance that your insurance company will NOT pay for the medication.

WHAT ARE THE CONSEQUENCES OF THIS TO YOUR DOCTOR AND TO YOU?

The additional time that the medication pre-authorization process takes would require that your doctor hire another employee to handle your insurance company’s extra paperwork and/or phone calls. Insurance companies demand steep discounts on your doctor’s fees, and they certainly do not pay your doctor for the time their extra medication pre-authorization paperwork takes.  And, prior authorization phone calls can go on for over 30 minutes!  After taking a close look at hiring additional personnel to handle insurance company medication pre-authorization paperwork, we at IPCA have realized that we cannot afford to do this now. We regret to inform our patients that, as a matter of routine, we cannot process insurance company demands for additional paperwork on medications. 

IS INFORMATION ON YOUR MEDICATION NEEDS ALREADY AVAILABLE TO YOUR INSURANCE COMPANY?

Yes. We always have and always will provide your insurance company with copies of your physician’s notes. These notes meet the guidelines for medical documentation required by Medicare, the Arizona State Medical Board, and good medical practice.

The fact is that it would cost the insurance companies money to take the time to read the doctor's notes - and so they create forms for doctors to fill out, to make their life easier.  Unfortunately, doctor's offices can no longer be in the business of constantly making life easier and cheaper for insurance companies - we need to focus on our patients with what little time remains after meeting all the regulatory and other requirements that attend the current Amercian medical system.  We at IPCA have approached insurance companies about developing standardized formats for physician notes that will help them and cut out prior authorization paperwork and phone calls - and a few have responded and collaborate with us.  Most do not.