insurance company « Struggling to Thrive

If you’ve dealt with getting a prescription filled at a pharmacy you may have come across this term at some point. When something requires prior authorization it means the insurance company must approve coverage for it before it can be purchased. Many children with feeding tubes run into this for acid reflux medications but there are other types of medications which also have these sorts of restrictions.

The mechanics for prior authorization can be extremely confusing because policies between insurance companies differ significantly. One company may approve a brand without any objection while it might be nearly impossible to get approval for anything else. If you switched insurance companies you might well find that one brand which was preferred before is almost impossible to get approval for once companies change.

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This week the case for our son’s feeding supplies and his formula was approved by the insurance company. We changed companies the first of the year and I began working to get the case set up with the new insurance company prior to the swap. Approval came almost exactly three months to the day after beginning the process.

Why did it take three months? Many, as in more than four or five, well-intentioned people thought they knew how to take care of the case and it turns out they were wrong. How could so many people be wrong? Some were new and simply didn’t know the answer. Most had been at their job for a while but things had changed and no one bothered to inform them. Everyone I spoke to was trying their best to help.

If you’ve never gone through this process before it may come as a surprise. Three months is actually not that bad to get everything in place if you’re changing insurance companies. Having a child with medical needs which require case management approval makes changing insurance companies complicated. Now that we’ve gotten through the process I feel comfortable sharing some tips on managing insurance companies, case management companies, supply companies, and frankly any large organization.

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