The Chore of Getting A Prior Authorization

If you have ever had to get a prior authorization for a medication, you probably know what I am going through. I have been trying to get Ava's new formula approved through our insurance for a week! Before going to her GI appointment at Boston Children's Hospital, I tried to be prepared. I researched different toddler formula options as she does not seem to be growing on her current formula (she still gets formula twice a day along with other beverages and solid food) but cannot simply have milk because the calorie and nutrition content does not meet her needs. I then called our insurance agency to find out what I would have to do to get the formula approved. I was told to have the doctor fill out a prior authorization form and to have it faxed to the number on the top of the form. They said this would take care of it and that the formula would then be covered. I printed out the necessary form and brought it with me to the appointment feeling very organized and prepared. The doctor agreed with my choice of formula, filled out the form, and I assumed faxed it. However, when I got to the pharmacy back at home (1 1/2 hours without traffic from the doctor), and handed the prescription to the pharmacist, I noticed that the form was underneath the prescription! Instead of faxing the form Ava's doctor gave it back to me. This began a battle that has been going on for a week. The insurance company insists that the form must be faxed from the doctors office or that the doctor must call their prior authorization department and speak to a representative. I left two messages at the doctors office before calling back and finally getting a real person. I told her what needed to be done and she said she would take care of it. Two days later I called the insurance company to see if it was all set, was informed it was not, and called the doctor's office again. I spoke to a different person who supposedly was faxing the form as she spoke to me. I called the insurance company the next morning and they said they never received it so I called and left another message for the doctor. This was yesterday. Today I called the insurance company again and they said they still do not have it so I called and left yet another message for the doctor. When this will get resolved, I have no idea, but I hope it is before I run out of her current formula! I have three cans left. We'll have to see....

My recommendation for anyone else who has to get a prior authorization for a medication, take the form to the doctors and make them fax it in front of you!!