[Lockbox]

Why Do Insurance Companies Require Prior Authorization?

In short, health insurance companies pre-authorize medications in order to keep healthcare costs low. By ensuring that your medication is medically necessary, up-to-date, as economical as possible, and isn’t being duplicated, health insurance companies can afford to provide more expensive medications to those who truly need it.

I love this, insurance company determines if “your medication is medically necessary”. Excuse me which medical school did they graduate from and are the licensed by your state to practice medicine? Also when did they examine you to determine that you do not need this medicine a DOCTOR prescribed! Or do they expect your doctor to work for free proving to the insurance company you need the prescription?

[mass55th]

"I love this, insurance company determines if “your medication is medically necessary”.

Unfortunately, there's a whole lot of that going on these days, and it isn't just the insurance companies doing it.

[eastexsteve]

I love this, insurance company determines if “your medication is medically necessary”.

You should, because the group of doctors reviewing it have more medical knowledge in their little finger than your family doctor. And, don't think they don't know your entire medical history, because they do. So yeah, it's a good thing.

It's to the insurance companies' benefit that you receive the best treatment for your condition. It costs them less if you don't end up in intensive care because some doctor in a rush prescribed you some ineffective or wrong meds. For example, in the case of Humana, they contract out the med referral review service to an independent group of medical EXPERTS in their specific fields. If they find a disagreement between what they think and what your doctor thinks, they will call and conference with your doctor to give him the opportunity to explain his path and method of treatment if you have a unique case. It's usually a 24-48 hour turnaround.

If you are having trouble getting a prescription filled, it's likely because your doctor is dragging his feet explaining himself as to why he prescribed a non-standard treatment. It's Humana's policy to abide by whatever the independent expert panel recommends, no matter the cost of treatment.

[Jim Noble]

In short, health insurance companies pre-authorize medications in order to keep healthcare costs low

Really working, isn't it?

[Jim Noble]

Or do they expect your doctor to work for free proving to the insurance company you need the prescription?

Yes.