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Understanding the Insurance Authorization Process for Specialty Fertility Medications
a blog by the Nursing Team at Dominion Fertility, December 17, 2015
Often times as nurses, we are called upon to engage in sometimes lengthy spirited debates with insurance companies in order to obtain prior authorization for medications commonly used during fertility treatment cycles. We thought it would be helpful to review what the process on our end is and how fertility patients can help move the process along.
When we call to obtain prior authorization, we have to complete several forms for the insurance company and submit with treatment plans. Sometimes we can complete the required information online, and if that option is available, we use it. After the forms are done – we wait. And wait. And call, then call again to see what the hold up is. The insurance companies don’t always see the urgency involved in getting that magical authorization number in your file. This is what is needed to actually order the medications.
Although it’s not required, it certainly can help the process if you call the insurance company to follow up and nudge them along. We have found that when we do our stuff, and you call on your end to add a little more pressure, you can actually get your medications sooner. So don’t hesitate to call the insurance yourself – you are the one paying for their services – they are in business for YOU!
Because of the nature of injectable fertility drugs, they are considered Specialty Medications. This means that they can’t be obtained at your local pharmacy. They need to come from either the insurance specific pharmacy or from a local specialty pharmacy. Having said that – you must allow time for the medications to be processed and delivered to you. Most of the specialty pharmacies are ones that will send your order through the mail. There are a couple local places we can call, but they may or may not be covered by your insurance plan.
A good rule of thumb to keep in mind, is to begin the process of obtaining your medications about two weeks prior to the start of your cycle. This way, there is time for us to get the authorizations (if needed), place the order and for you to coordinate the payment and delivery. The process is not always without frustration, and we get it. We are always on your side, and happy to help do anything we can. Don’t wait until the last minute to think about your meds – start the process early. Doing this can only reduce stress and make the process at least a little bit easier!