Thursday, November 11

Prior Insurance Authorization and Narcolepsy

This last hiatus from my blog was not a good one.

Several days ago my husband ran out of his medication. When he attempted to get his prescription refilled, our insurance company told us that he would he need to obtain prior authorization from his physician. That authorization is a real pain because the insurance company asks for it every few months - we never know when - and they won't pay for his medicine without it. Typically it takes a couple of days, but this time it took several. 

My husband's first day without his medicine wasn't intolerable. He was a little tired, but he made it through.

The next day, however, he was exhausted, irritable, and slightly depressed. It was as if he had a bad hangover.

By the third day, he was a zombie. He slept for the entire day, until I eventually woke him to eat something. After eating, he promptly went back to sleep. It had been a long time since I had seen him sleep for an entire day. I'd forgotten how scary it was.

Watching him go for days without the medicine he needed to function made me sad - and angry. I started to wonder, just what is a prior authorization anyway? Why is it still required after years of being with the same company, and getting the same medication?

A prior authorization is something the insurance company requests when they aren't sure they want to pay for your medicine. This is more likely when your medicine is very expensive, has an age-limit, or is not usually covered by insurance (among other reasons). Usually the insurance company sends a form to your physician, they fill it out, and send it back. Once your insurance company decides to pay for your medicine - or not - you may still have to get prior authorizations every now and then. You may need to get them every 3-4 months like my husband, or maybe once a year... it depends on the company.


Because my husband's authorization took longer than usual, I called the insurance company to complain. As his advocate, I wanted them to know just how detrimentally he was affected by their dragging feet. They approved the medicine the next day and today he's back to normal.

For now, I'm relieved, but I know it's just a matter of time before we'll go through this rigmarole all over again.

4 comments:

  1. Sorry ya'll had such a problem-insurance is a racket for sure. But thanks for reminding me that I have to renew my prior auth...again.
    Hang in there-good to see you posting again.....

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  2. You should tell your doctor to use www.covermymeds.com. It is a great site for docs and pharmacists

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  3. so sorry that you went through that and happy that he has his meds. hang in there

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  4. Thanks for the support guys. It's a shame how difficult it is to get medical help in the United States sometimes. It really put a new spin on the whole health care debate for me.

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