Insurance…It’s Getting Even Harder for Patients. Here’s What You Can Do.

Insurance companies are making it much harder for people to get the medications their doctors prescribe. Here are some things you should understand about how insurance handles prescriptions:

1) Insurance may require a ‘prior authorization’ before the prescription can be filled. This means that after the prescription is written and goes to the pharmacy, the insurance company then wants another authorization from the doctor’s office before allowing the pharmacy to fill the prescription.

2) To get a prior authorization, the pharmacy will fax the prescribing doctor with a request. The doctor must then fill out paperwork and submit it to the insurance. The insurance will then review the paperwork and make a decision about whether or not they will authorize the medication. If accepted, the insurance must contact the pharmacy to permit the prescription. If not accepted, the insurance will send a letter or fax to the doctor or the patient explaining their decision.

3) The prior authorization process can take anywhere from 8 hours to 4 weeks to complete. At CPCH, we complete the prior authorization immediately; however, many psychiatry practices do not have administrative staff to help with this and it can take much longer.

4) If the prior authorization is accepted, it may have limitations like:

What can you do as a patient to make this process smoother?

1. Ask your insurance provider for a listing off all generic and brand named medications that are covered under your plan.

2. Take this list with you when you go to your appointment and show it to your doctor.

3. Choose a psychiatry practice with a lot of experience with prior authorizations and an administrative staff member who is dedicated to this task.

If you have any questions about this, please feel free to use our chat option on our website or reach out to by email or phone. We are happy to assist you.

Live Mentally Healthy,
Dr. Jennie Byrne,

Author
Dr. Jennie Byrne, M.D., PhD. With over 15 years of medical expertise, Jennie Byrne, MD, PhD, is a board-certified psychiatrist with experience treating mental health conditions in adults, including dementia, attention-deficit hyperactivity disorder, anxiety, and depression. After practicing in New York City for 12 years, Dr. Byrne relocated to North Carolina in 2008; she currently cares for patients in Chapel Hill, North Carolina, at Cognitive Psychiatry of Chapel Hill. Dr. Byrne earned her bachelor’s degree at the University of Pennsylvania in Philadelphia. She then received her doctorate from New York University Department of Neurophysiology. She also has a doctorate of medicine from New York University School of Medicine. Dr. Byrne went on to complete a psychiatry residency at Mt. Sinai School of Medicine in New York. In addition to her work as a psychiatrist, Dr. Byrne has performed extensive research on attention, memory, and depression. As a board-certified adult psychiatrist, Dr. Byrne focuses on the needs of each patient to pro

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