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Current Trends in Insurance Prior Authorization for Telehealth
Stay ahead of the curve in telehealth! From ePA adoption to AI-driven workflows, updated payer policies, smoother provider–payer collaboration, and a stronger focus on patient experience; these trends are fast reshaping prior authorization in 2025. Click to read how they impact your practice.
how to renew a prescription in 2025
Step 1: Submit a renewal request to your doctor's office
Step 2: Receive an "incomplete information" notice from the pharmacy. Belatedly inform your insurance company that your PCP has changed
Step 3: Receive a "refill is too soon" notice from the pharmacy. Inform your pharmacist that you last got a 30-day supply of this medication 2 months ago, so it cannot possibly be too soon
Step 4: Hear from your pharmacist that your doctor's office hasn't submitted a prior auth, which it needs to do because your doctor changed. Contact doctor to ask for a prior auth
Step 5: Hear from your doctor that the prior auth came through. Contact pharmacist to inform him
Step 6: Hear from the pharmacist that your prior auth is not in the system. Contact Doctor and ask them to double check
Step 7: The doctor says your prior auth was definitely approved. Wait a day to see if the computers catch up, and then ask the pharmacist to check again
Step 8: The prior auth is still not in the system. The next day, send an in-app message asking the pharmacist to just fill it out-of-pocket if it's still not covered, because you are running out of time to fill the script
Step 9: After not hearing back from the pharmacy for a day, send a phone message to the same effect
Step 10: Receive a call from the pharmacist telling you that due to a new law they cannot fill this script out of pocket unless the insurance company informs the pharmacy that the script is denied. The insurance company is not approving or denying the prior auth for the pharmacy, so the scripts cannot be legally filled. Briefly freak out, then offer earnest condolences to the pharmacist because it sucks that having this conversation is part of his day job
Step 11: Contact your doctor's office and very sweetly and politely ask them to rip your insurance company a new asshole
Step 12: I'll let you know when I find out 🙃🙃🙃
Mastering the Challenges of Complex Rehab Technology Billing
From prior authorizations to payer-specific rules, CRT billing demands precision and strategy. This guide breaks down essential steps and highlights best practices to help providers streamline billing processes and improve financial outcomes in this highly specialized field.
How Do Physicians Feel About Prior Authorization?
Physicians generally express significant frustration and dissatisfaction with the prior authorization (PA) process, citing it as an essential administrative burden that negatively impacts clinical practice and patient care. A survey of the American Association of Hip and Knee Surgeons (AAHKS) revealed that 95% of surgeons noted increased PA requirements over the past five years, with 93%…
How U.S. Healthcare Spending Fails Patients
I'm sharing an article reviewing reasons why a healthcare executive was targeted for violence. It has provoked much soul searching about an industry that touches all of our lives, a situation that must be addressed.
Like you, I have been following the news stories of Brian Thompson and Luigi Mangione. I can’t remember another time when an alleged killer received more understanding and sympathy than the victim. (Although it has probably happened.) Based on what is known now, the murder was connected to one man’s occupation, healthcare insurance executive, and the other man’s grievance, healthcare cost and…
In a new survey by the American Medical Association, physicians reported that PA demands have a negative impact on patient clinical outcomes.
In a new survey by the American Medical Association, physicians reported that PA demands have a negative impact on patient clinical outcomes.
6 barriers to automating prior authorizations
6 barriers to automating prior authorizations
Prior authorizations consume hours of physician time as they seek insurer approval for drugs and treatments. Health plans say prior auths improve the quality of care and manage healthcare spending, but doctors say they infringe on their autonomy and take time away from patients.
According to CAQH CORE, an industry group representing health plans, providers, vendors and government entities,…
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I am a medical student in France, and I follow you for a long time now, quietly. But, reading your explanation about prior authorization, I couldn't stop myself. I mean, with all that useless paperwork, how do you even get real medical work done ? How can you even find time to treat your patient if you have to justified (to no medical people !) practically every drugs or tests you prescribe ?? oO I just can't even conceive how you survive in such a system... (sorry about my bad English)
Ah, someone who gets it.
To be fair though, we’re not doing PAs for everything we prescribe or order. It’s a small fraction of the prescriptions we write. But it’s still enough to be time consuming. And PAs are just one kind of form we have to fill out. There’s lots more that get thrown our way. I honestly think a doctor could easily fill up one half day a week just doing paperwork (not counting writing progress notes).
