IPCA POLICY ON INSURANCE PREAUTHORIZATION FOR MEDICATIONS
We will not fill out insurance company medication pre-authorization forms.
Our patients deserve to know why.
WHAT IS “PRE-AUTHORIZATION” FOR MEDICATIONS?
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?
Your insurance company does not use your doctor’s notes and records to decide when they will or will not cover the cost of medicines. They could. But no, instead they require that your doctor fill out and submit for their review a special “medication pre-authorization form”. The information your insurance company wants on these extra forms is 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, 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. 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. 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 policy, 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.
