Our family doctor is doing something really stupid, and I’m not sure what action to take (other than change doctors, which we are doing).
He’s an experienced doctor, so this makes no sense whatsoever:
One of my wife’s medications requires prior authorization. He refilled the prescription with no issues, but when we asked him to initiate the prior authorization with Walgreens, he said WE had to do that. It didn’t even help when we, and Walgreens, tried to convince him that it was his job, not ours. So we’ve been refilling it and paying the whole cost for the last 4 months.
The kicker was last month, when my wife tried AGAIN to get him to do it. He recommended pharmacies that would sell it cheaper. Um, if you would do your job it would cost us NOTHING, Dr Doofus!
Who do we complain to? I would guess his office manager, but we plan to switch to another doctor in the same office and I don’t want to burn bridges there. Blue Cross doesn’t seem to have any contacts for issues like this, but they must have some procedure, somewhere. Maybe the patient advocate at his affiliated hospital? I just don’t know.
This is a strange issue. He doesn’t seem lazy, and I can’t see how he could practice for years without figuring this out.
I would talk to either the office manager or call and ask the person who ‘handles the billing’. Just explain that you need a prior authorization for one of your scripts called in by the doctor but he doesn’t seem to understand what you’re asking for.
Better yet, ask for his nurse since she deals directly with him and can probably get everything set up so all he has to do is sign a paper that she can take and fax to the insurance company. Even better, if there’s a PA at the office, they can do it for you.
It sounds like he’s just not understanding what you’re asking for. I’m not sure how you can be a doctor and not know what a prior authorization is though.
Even in this day and age, some doctors are clueless about anything outside their exam rooms - the matron in the front office runs everything and “Doctor” is just another exasperating employee to her. A rather old-school arrangement but I’ve seen it recently.
Personally, I wouldn’t accept that Blue Cross doesn’t have a contact for issues like this. They’re supposed to pay for your medicine, and they aren’t. THEY want prior authorization before THEY pay the bill, THEY need to help you with the process, it’s their process.
Just to be clear, the prior auth is for your insurance company, not the pharmacy.
Also, if you talk to him again, don’t say things like ‘it’s too expensive’ or ‘paying full price’ that’s what’s confusing him and why he recommended places to get your meds cheaper. Just say ‘our insurance won’t cover the med without a prior authorization, could you please take care of that’.
Like I said earlier, it may be easier to have his nurse get the ball rolling on it.
That’s not really how it works though. BCBS is saying 'oooh, you want this med, sorry, if you want it, we need to know that you’ve tried these other meds first or that your doctor specifically wants you to bypass these other cheaper alternatives".
For example, if you want Imitrex, the insurance company might request that you first try Tylenol and Topomax before they’ll cover Imitrex. But, if the doctor sends them a prior auth form saying that you’ve already tried those drugs and/or your migranes are severe enough to warrant bypassing Topomax which takes a few months to work, then they’ll give it to you.
IOW, BCBS is asking the doctor to defend the med he prescribed (and maybe suggesting some cheaper things to try first).
What’s not fine is telling your customer that BCBS doesn’t have any person who can be contacted about prior authorization issues. They have someone, and that person should be working with Rocket Surgery! and his doctor’s office to ensure that BCBS has the information they need.
I’m sure they do. Rocket Surgery needs to call the number on the back of his card and say ‘Hi, Walgreens told me I need to get a prior auth on one of my meds. Can you help me out with that’ and go from there. At the most they’ll do the legwork for him (including contacting the dr’s office, calling him back to let him know it’s a go and even refunding him for the scripts he already picked up), at the very least the should tell him exactly what to do.
My guess, if RS did call, they probably don’t have an actual customer contact in the prior auth department, but the customer service rep that answers the phone should be able to walk him through the steps. Possible even emailing RS the prior auth form so that he can take it to the doctor’s office, have him fill is out and then fax or email it back himself.
Stop there. That’s your problem. You’re confusing him, because you don’t need him to initiate the prior authorization with Walgreens. That’s called “a prescription,” and he’s done that (or you couldn’t be picking up your meds.)
You need him to initiate the prior authorization with your insurance company. Not Walgreens. Bringing up Walgreens is confusing him.
I agree that speaking with his receptionist or nurse is the way to go. They’re largely the ones that actually do the paperwork, even though he has to sign it.
Now, if he’s not confused, he’s just unwilling, then that’s another matter. Then you do need to find another doctor, who’s willing to play ball. Prior authorizations are a pain in the butt, but it’s part of modern medicine.
This was pretty close. Today, I found the prior auth form on the BC/BS site, filled out our part, and faxed it to the doctor’s office. If he STILL doesn’t complete the form, all bets are off.
For the people who were mentioning cheaper alternatives, this is actually a generic. The prior approval is because it’s on the “potential for abuse” list (Ambien).
It might be confusion. My wife has been dealing with this and I’m just now stepping in. Who said what to whom, I don’t know. I do know some of her requests for prior approval were through the hospital’s YourHealth link, so there’s a record I (or they) can check.