#prior auth

[drnic1]

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Each and every year there’s a rush for predictions for the coming year and 2024 is no different The Year of AI and Skynet Becoming Active The year Skynet/Mednet became active – not really but that was the fear with everyone calling it the Year of AI. For the rest of us, it was not so much the year of AI but rather the year that everyone else became aware of AI. Before we get into the…

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[a2msolution]

Payment Posting

To provide the #financial picture of medical practice by depicting the #insurancepayments in EOBs, including #patient #payments and #insurance checks from #ERAS.

Denials

To account for the count of #claims denial along with analyzing the causes behind such occurrences to undertake the necessary steps at the earliest.

Accounts Receivable

To follow-up the denied or rejected claims so as to reopen them with full evidence to receive 100% #reimbursements from the insurers.

Charge Posting

To make sure there will be no rejections after sending a claim to insurance to follow every guideline according to the Speciality. Correct use of modifiers updated ICD and billed amount , with accurate CPT.

Rejections

Some times numerous rejected claims get stuck in the clearing house, so we make sure to assign a professional who can fix all of them and send them to insurance.

Patient Collection

To have a dedicated professional who can do daily and regular followups on patient's due balance to collect their balances on your behalf.

Eligibility And Verification

To make time for your patients and the front office, we provide dedicated FTE to who can check eligibility and benefits before patients arrive for their appointment and also get authorization in advance for the procedures that need authorization.

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[sepulchritude]

This bitch made me spell testosterone. WHILE calling me ma’am the entire time.

#girl WHAT just fix the prior auth 😭😭😭 #dealing with insurance is an entire layer of hell all on its own #sepulchritudinous #testosterone

[pelipper]

My superpower is being so chronically ill that one refill of my medications cause us to hit our maximum out of pocket in January (with the deductible being covered by the company that makes my medication minus 5 dollars), so we're able to enjoy "free healthcare" for the rest of the calendar year.

#just filled a prescription for dificid and it cost cigna 7k #eat shit cigna #this is what you get for dragging your heels on my prior auth earlier this year #which made me end up in the hospital and resulted in an bowel resection and ileostomy #my one solace is that i didn't have to pay anything for my hospitalizations or surgeries because we already hit our max oop for the year #tw: medical #aly speaks

[daimonios]

im just trying to get hairy and grow a dick can my insurance just give me my testosterone for fucks sake

#prior auth kill yourself!!!!! #personal

[vixvaporub]

Working in healthcare reminds me on the daily that the US medical system is fucked up but a recent example that hasn't escaped my mind for weeks is that a patient with a new diagnosis for HIV was trying to get his medication... but his insurance rejected it and said that they don't cover any HIV meds

#it was also first line treatment too #doctor had to write a letter and everything #and i think they still didnt cover it cause they had to get samples or something so the patient could get something treat his hiv #idk how that is even legal #no one can convince me that private insurance is good when shit like this happens #also saw a doctor talk about how he had to do a prior auth for Lisinopril #Lisinopril... cheap ass drug that is used like crazy #also dont get cvs caremark

[transdelgado]

are y’all actually able to fill your testosterone prescription on a monthly basis or is the issue florida. genuinely curious

#i’ve been back on for 4 months… been off of it a month of those 4 cause i keep having issues w my script #different issues tho. like rn since i switched insurances the prior auth keeps bouncing 🤩🤩🤩

[chrisabins]

i have been through the fucking ringer trying to get my synthroid jfc

#sam.txt #health bs #ups lost the bottle from the online pharmacy #they’re gonna take a week to get the replacement shipped #so i contacted my primary doc #who is taking over the prescription and calling in to my usual pharmacy #then the prior auth form got the wrong dose #and had to be re-sent by the nurse #but NOW it’s being filled #hopefully i have it before friday since im out of it on thursday #its so annoying that insurance is shitty abt brand name meds

[ballsballsbowls]

In case you think it doesn’t happen to people who work in pharmacies:

1. Go to refill my asthma medication as I’m moderately low.

2. Call my PCP, who filled it for me last time as I didn’t see my pulmonologist because I was buying a house and getting a root canal in 2021

3. “That’s Dr. Pulmonologist's script and we won’t refill it.”

4. Call Dr. Pulmonologist, get an appointment for 4 weeks from the day (which is the only good step in this whole miserable chain)

5. Put in a refill on their line as I now have an appointment.

6. They don’t refill it, presumably as I am Not An Active Patient as I haven’t been seen since 2020.

7. Get seen a month later with like 7 days of meds left.

8. Ask for a sample or something as I suspect my meds will need Prior Auth as I am on a weird ass asthma med after trying 3 other ones prior and having a HOST of side effects.

9. Get a 14 day sample (spoiler: it’s giving me side effects) begrudgingly because she figures that everything will be resolved within 10 days anyway.

That was July 25th. I still don’t have any meds OR any updates on the status of my Prior Auth and I am going to very much be out of meds.

I have to say: this is 100% not my doc’s fault, and I know that in spite of having worked retail pharmacy in the past where docs are the problem in a LOT of these cases (or at least partially the problem), because we’ve had to do a prior auth for this specific med a couple of times over the years and I’ve never had this much trouble before.  

#anyway we complain about prior auths a lot here on tumblr in general #but having to do a prior auth for a med I've taken for 7 or 8 YEARS after trying 3 other ones because I switched insurances is EVIL #I should be able to go 'I;ve been taking this med since 2015 and I tried these other ones' on a single sheet of paper #and they should fall all over themselves to get me my meds that I have taken for years #I even grudgingly respect the hustle when it's a brand new script! I get it! I hate it but there's a logic #stop b think of the children

[sepulchritude]

Just picked up my new testosterone from the pharmacy!!

#it was 75 whole dollars which is not ideal but that works out to like 7.50 per week which is. acceptable #maybe the lady from earlier got it figured out and just didn’t call back #or more likely my doctor sent in a revised prior auth request #sepulchritudinous #testosterone

[anonymusbosch]

oughhhhh medical system.

#i do not have Medications. i do not have Treatments. but i have Bills. why the Bills but not the Treatments. i called. i emailed. #today i have been in the drs office for 42 minutes waiting to be seen #I haven't been able to fill a narcolepsy med (critical to my ability to exist) since jan 20 #i made 2 phone calls to insurance and 2 to the doctor and 2 to the pharmacy and noooooo drugs for me #gotta call again today #prior auth expired and nobody has fixed this yet or notified me #until i went to the pharmacy in person and asked #when i sprained my wrist and needed a brace the technician forming the brace kept taking his hand off it to text on his apple watch #this only takes 2 minutes dude. please. it can wait #the doctor couldn't show me the results of the mri and called me in for an appointment to tell mw there was nothing wrong. #this could have been a voicemail but instead it took an hour and also cost money #didn't even answer things like 'which tendon is affected' when i asked #also a different doctor misbilled me for an extra $135 and i had to make several emails and four phone calls and it's still not fixed #but they charged the card on file while I had an active dispute of the charge and haven't refunded it #this is just so exhausting! #and i have really good insurance thru work and no life-threatening conditions and i have enough meds stockpiled to last a little longer. #and YET #yet it still makes me want to get crushed in a hydraulic press a little bit #that a med I have used for five years that previously had a multi-year prior auth can just disappear off the face of the earth #and no one warned me #no notification about the prior auth about to expire #no alert that i needed to renew it #I didn't even know they could expire #boy i die. shit boy

[bellshazes]

I think I need to start making everything everybody else's problem. no more of this sensitivity to busy schedules shit. I'm tired of not knowing what utilization management does and as penance I'll invent the fucking system map if someone besides me will start explaining interdepartmental collaborations.

#unfortunately i believe that prior auth is inherently evil. #so i find it hard to engage with that part of the business. and mds are such a Type #work woes

[coldbug]

i ran out of my ritalin-type meds bc there’s a delay approving the prior authorization and todays my first day without it and it’s funny the way i can really feel. so unfocused? normally i’m at work on my phone for a bit and then i can p easily switch back to answering emails and stuff but. not today! also my head hurts (which i knew was gonna happen)

#i’ll probably feel like more shit tomorrow #cause idk when the prior authorization will be approved 🙃 #so silly of me to want to try a higher dose and therefore need a new prior auth!

[planetary-wolf]

I love how shocked I was just now on the phone with the nurse I'm seeing for HRT

"Your testosterone was at 29 which is what we expect from someone not on testosterone therapy."

"Okay."

"Our goal is somewhere in the 400-700 range"

my brain went "WTF"

#just gotta wait for a prior auth #and i'll be on that sweet sweet boy juice

[coccolithophore]

hate wins 🥰❤️

#insurance should end up covering this but i’m just sooooooo mad lmao #i would be over 100k in debt if i didn’t get prior auth #kiwi.txt #kiwis cancer diaries #this file name is lol.png #i have several 1-3k charges processing too #but those are the small ones………