How to get a Prior Authorization — RN-style
This is a message for all you nurses out there. This post is now the PREMIER AUTHORITY on how to get prior authorizations -- in STEP BY STEP FASHION. It's an overly simple 4 and 1/2 step process. As a wonderful "side effect" of this process, you will waste at least one week of a pharmacist's time and, an added bonus, really piss them off as well. It's a win-win for every RN!
4) REPLY TO ALL FAXES REQUESTING YOU GET A PRIOR AUTHORIZATION BY SIGNING IT AND AUTHORIZING "1+2" REFILLS. This is a GREAT way to both waste a pharmacist's time and really frustrate them. In most instances, they've told the patient 48-72 hours. By replying to the fax with refills, you show that you really want the patient to get the medicine, but it shows the pharmacy that you've got better things to do than read their stupid faxes. To really put a cherry on top of this one, schedule the fax to send at 4:55pm. This will ensure that even if the fax even goes through successfully in the first place, the pharmacy can't contact you again until the next day because the phones cut off at 5pm on the dot (and you cut out at 4:30pm in the first place)!
3) When they call you the next morning, make sure they have to leave you a voicemail. If you're feeling particularly randy, respond to that with a copy of the fax from the day before and a SNARKY NOTE at the bottom of the fax. Some suggestions for the note are:
"Authorized (1+2) yesterday. Is your fax machine working?"
"I got your VM -- here's the auth you need. Thought I faxed this yesterday. WEIRD!!
You could also just skip the reply all together...
2) When they finally get a hold of you at the end of the second or the third day, tell them your office's standard is at least 3-5 business days on a PA Request. Tell them you'll get back with them at the beginning of next week. After you say this, don't do anything. Don't even ATTEMPT to get the prior authorization. Why you ask? Duh -- the pharmacist will probably call and remind you again on Tuesday or Wednesday when you actually need to do it anyway. Out of sight out of mind! [If you wanna be a real bitch, at this point you need to send another refill authorization in to pharmacy. No note this time -- you don't want to appear "catty."]
1) After they call you Wednesday, if it's a different pharmacist than the one you talked to the previous week you need to go off on him. Make a huge scene. Act as if everything that was sent in and you cannot figure out why the pharmacy refuses to fill the prescription. When they explain the PA Process to you, acknowledge it, say you'll get right on top of it, and completely ignore every word of it. At this point you need to go straight to your doctor and tell them the following, "Doc, I don't know what the heck is wrong with Walgreens. They are pretty much refusing to fill Mr. Johnson's _________. I've dealt with several different members of their staff. I've faxed in the prescription at least two different times, called it in once, and I can't seem to get them to fill it!" Then, the doctor will call and ABSOLUTELY TEAR THAT STUPID PHARMACIST A NEW ONE! Sit back and laugh. You've done a good job. You've waste almost a week of the pharmacist's time, and you've not had to do much work or call for the PA.
Final Step) Now, when the doctor returns to you, he'll explain to you that they just need you to get a PA. They'll be so scared of the doctor, they won't say anything about your prior shenanigans. Your response should be, "Well, why didn't they just SAY THAT!?! STUPID PHARMACISTS!" He will agree and, at this point, you need to call the pharmacy again and have them fax you the information on how to get the Prior Authorization. They will probably say something about how they sent you the information -- just tell them you never got anything. Now, buckle down and actually get the PA...dag nabbit!!
And that is how you get a PA!
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a little off topic, but since you brought up communication(s) b/w pharmacies and MD’s offices, here’s a story:
a couple of weeks ago, a doctor was, oh what’s the word, “annoyed” i guess, that we had sent his office three faxes for refill authorizations, all for the same patient. he faxed back on one them, “IS THREE FAXES REALLY NECESSARY?! MAYBE I CAN START CHARGING YOU FOR PAPER FOR THE FAX MACHINE. P.S. YOUR ELECTRONIC E-FILL SYSTEM IS !@#*@”
fucking passive-aggressive asshole.
Please tell me you faxed it back with “DID YOU RESPOND TO THE FIRST OR SECOND??”
no, i did not fax back anything although i was VERY tempted. i figured if i did fax back, then i would just show that i let him get to us emotionally and it wasn’t worth it.
I love nothing more than faxing a prior auth over to a nurse at least twice, then they call days later saying that Mr. Smith says something is wrong with the rx and they are trying to find out what the problem is. You explain to them that the drug requires a pa, and they tell you to fax over the frickin number again. Many times I have offered to give them the number right then but most of the time they insist you fax it over again. Why stupid? You are just going to lose this one too.
every p/a request i fax to an md’s office, i outline the patient’s name, the prescription information and the rejection message. i then usually write a note along the lines of, “please call the # below to set up prior authorization. thanks! (i also write the phone # here). if the phone # is listed on the rejection message, i will underline it along with “prior authorization required.” seriously, i don’t think there is anything more i could do other than go over to the md’s office myself, wipe their asses, and set up the p/a myself.
Jr, re: your first comment – I have a doctor who clearly hasn’t mastered his e-script program. I sent him three requests for a patient who was going away and didn’t bother to check the bottle more than three days before they left, and he called me on the very last day and bitched me out. I told him maybe if he would’ve answered it and seen the note saying *Patient Leaving Town – Needs ASAP!* maybe they wouldn’t have asked me to send repeated requests! Apparently calling his office got them no further too, as his voicemail instructed them to have me get the script. What a jerk. I refuse to send more than one request now and tell the patient to talk to a nurse.
This post made me sad in a sad way. I spoke to a nurse yesterday about a prior auth that had been sitting since before I took a week vacation. She said snottily “Why didn’t you send it over?” I listed in a monotone voice the different dates throughout the week they had been contacted. She paused and asked for the PA phone number. I wanted to scream. I didn’t though.
Either EVERYONE works at Walgreens, ORRRRRRRRRRR all doctors offices operate the same way. I can’t believe that I was so ignorant to believe that it was just my pharmacy that had these problems. EVERY time I send over a PA, my system allows me to select PA, and it puts a header at the top of the fax in bold 24 pt font size PRIOR AUTH NEEDED, and I still have to put “THIS IS NOT A REFILL REQUEST!!!!!” (always at LEAST 5 exclamation marks) exactly like that in the faxes text box just to get the point across, EVEN with all of that, they still just sign the damn paper and fax it back to us not reading it, treating it like a refill request.
Yeah, how stupid. That drives me mad. Is it standard practice to refill everything that comes across your desk without even a simple pull of a chart or reading the fucking piece of paper? WOW!
I recently left the retail world to work at an insurance company who deals exclusively with Medicare and Medicaid. I was royally pissed when I learned how frigging easy it was for a doctor/nurse to get a prior auth. When I was in retail I figured it must be a drawn out process because our PA requests would take weeks before we got any response. Now that I am on the other side, I discover that it is a single sheet of paper. 3/4 of the form is basic demographics. If the provider is feeling particularly lazy they can call us and WE can fill it out FOR THEM. I can have the thing done and sent to the PA department in 6 minutes FLAT. Plus when we get the form we must have made the decision in 72 hours or less. There is no excuse for PA requests languishing in the pharmacy callback bins…. nurses are just.too damn lazy.
You had me laughing. This was a great description of what I imagine going on over there.
Being on the receiving end of a health professional taking her time getting a prior authorization for a medication that involved an 11yr old boy. She was informed on a Saturday waited until 4ish on Monday evening to put it through. Then when the insurance company said she left off two questions she left a message Thursday morning stating the numbers for my insurance were not working etc. She accused me of lambasting her and she was doing all she could! I basically told her that her priorities are not straight and she was playing with the well being of an 11 year old boy. So this is all well and good that RN’s and other health care professionals create articles about how funny it is that they are not doing their jobs. In this case it was an 11 year old boy. You are all pieces of shit who don’t belong in your positions.
You are a very thick person. As a pharmacist, I’m on the patient’s team you IDIOT. The point of this article was satire. I am making fun of the fact that some nurses and some doctor’s offices are worthless when it comes to getting PA’s for anyone. However, since I’ve now had to explain a satirical article, it all but loses its mystique and luster.
Next time, think before you make stupid comments blasting something you skimmed over and therefore didn’t understand.
I enjoyed the satire in your article immensely. You pretty much summed up what is going on behind the scenes with the nurses at the doctor’s offices, while we, the pharmacists, have our hands tied waiting on them to get around to calling the insurance company and getting the paperwork filled out for the prior authorization. Sad, but so true!
yes i know the pharmacies will say oh we did fax it we have not heard from the md
then i have to call MD and pharmacies always for a refile why/
poor training.