Guest guest Posted June 14, 2004 Report Share Posted June 14, 2004 thanks for the list...unfortunately, no one knew my insurance was going to require a reauthorization. i'm the first xolair person in the office, and the insurance did not give us a warning bell, nor did they say in the beginning we'd need reauthorization. as of today, it was not authorized...so i'm assuming i am not getting it this thursday...which really sucks. --- In , " keemaka42 " <keemaka42@y...> wrote: > Here are some tips for handling any kind of re-authorization. These > were learned the hard, way, getting a drug approved that is much more > expensive than Xolair. > > 1. Start Early (six weeks ahead of time). Contact the insurance > company yourself, ask them EXACTLY what documentation they need and > get the name, phone number and address of the person to send it to AND > the same info on the person who gives you this information. > > 2. Give the list to your doctor's office in writing, along with the > address, and ask who to check with to see if it is getting > done...check with them regularly every week to ten days. When the info > is gathered, send not only what they ask for, send a summary letter of > your progress written by your doctor, copies of your applicable lab > tests and copies of doctor notes. Insist that the info be both faxed > AND mailed, with some kind of tracking, to the insurance company. > (Tell the doctor's office you have discovered this is the best way to > make the insurance co. behave). > > 3. Allow appropriate delivery time, then call the insurance folks to > be sure the info has arrived. Again, get name and phone number of the > person you talked to. If they tell you it has not arrived, whip out > your proof of delivery and dazle 'em! > > 4. In the US, most states require them to answer you in writing in 30 > days, so you can harass them if you have not heard. Your doctor can > start calling them telling them your therapy is in jeopardy, etc. > > 5. Remember that the doctor's office is not the enemy...they deal with > the ins. companies daily. I find that having proof of delivery cuts > down on the claims of " it never got here " . > > Employees of these companies are not well paid and it shows...I had > one say it was too far to walk to the other end of a building to see > if a fax had come in and I would have to wait until it came to her > desk via inter office mail! (Cigna if anyone wants to know) > > Mostly, send every bit of documentation you have, and keep detailed > records of every contact you have. The authorization process consists > of clerks with a check list to go through...if something is missing > from the checklist, they kick it back. No doctor or nurse ever sees it > until the whole package is together. > > Happy re-authorizing! > > P. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2004 Report Share Posted June 15, 2004 Hi heather, My doctor normally oders injenctions for the next 2 months for me. So if there are any problems in re-authorization, then at least I am covered. If you are having problems with your insurance company, and I know we are both in the NYC same area, maybe my doctor can help. He is excellent and has a number of Xolair patients. Let me know, and I can forward you his details. I would hate for you to miss your next shot! Ash > > Here are some tips for handling any kind of re-authorization. These > > were learned the hard, way, getting a drug approved that is much > more > > expensive than Xolair. > > > > 1. Start Early (six weeks ahead of time). Contact the insurance > > company yourself, ask them EXACTLY what documentation they need and > > get the name, phone number and address of the person to send it to > AND > > the same info on the person who gives you this information. > > > > 2. Give the list to your doctor's office in writing, along with the > > address, and ask who to check with to see if it is getting > > done...check with them regularly every week to ten days. When the > info > > is gathered, send not only what they ask for, send a summary > letter of > > your progress written by your doctor, copies of your applicable lab > > tests and copies of doctor notes. Insist that the info be both > faxed > > AND mailed, with some kind of tracking, to the insurance company. > > (Tell the doctor's office you have discovered this is the best way > to > > make the insurance co. behave). > > > > 3. Allow appropriate delivery time, then call the insurance folks > to > > be sure the info has arrived. Again, get name and phone number of > the > > person you talked to. If they tell you it has not arrived, whip out > > your proof of delivery and dazle 'em! > > > > 4. In the US, most states require them to answer you in writing > in 30 > > days, so you can harass them if you have not heard. Your doctor can > > start calling them telling them your therapy is in jeopardy, etc. > > > > 5. Remember that the doctor's office is not the enemy...they deal > with > > the ins. companies daily. I find that having proof of delivery cuts > > down on the claims of " it never got here " . > > > > Employees of these companies are not well paid and it shows...I had > > one say it was too far to walk to the other end of a building to > see > > if a fax had come in and I would have to wait until it came to her > > desk via inter office mail! (Cigna if anyone wants to know) > > > > Mostly, send every bit of documentation you have, and keep detailed > > records of every contact you have. The authorization process > consists > > of clerks with a check list to go through...if something is missing > > from the checklist, they kick it back. No doctor or nurse ever > sees it > > until the whole package is together. > > > > Happy re-authorizing! > > > > P. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2004 Report Share Posted June 15, 2004 hi ash! thanks for the help..sure, send me his info,if you don't mind. i did find out what happened...my insurance company decided to be dumb (i know, you're shocked!!!). my case was given to someone else...well, the person it was given to has been on vacation from the day they gave her the case until tomorrow. i'm assuming all my paperwork is sitting on her desk. i tried to leave her a voice mail today, but her VM isn't picking up. i'm doubting i'll be getting my shot this week (insert mad face)...maybe i'll be happily surprised!! thanks again heather > > > Here are some tips for handling any kind of re-authorization. > These > > > were learned the hard, way, getting a drug approved that is much > > more > > > expensive than Xolair. > > > > > > 1. Start Early (six weeks ahead of time). Contact the insurance > > > company yourself, ask them EXACTLY what documentation they need > and > > > get the name, phone number and address of the person to send it > to > > AND > > > the same info on the person who gives you this information. > > > > > > 2. Give the list to your doctor's office in writing, along with > the > > > address, and ask who to check with to see if it is getting > > > done...check with them regularly every week to ten days. When the > > info > > > is gathered, send not only what they ask for, send a summary > > letter of > > > your progress written by your doctor, copies of your applicable > lab > > > tests and copies of doctor notes. Insist that the info be both > > faxed > > > AND mailed, with some kind of tracking, to the insurance company. > > > (Tell the doctor's office you have discovered this is the best > way > > to > > > make the insurance co. behave). > > > > > > 3. Allow appropriate delivery time, then call the insurance folks > > to > > > be sure the info has arrived. Again, get name and phone number of > > the > > > person you talked to. If they tell you it has not arrived, whip > out > > > your proof of delivery and dazle 'em! > > > > > > 4. In the US, most states require them to answer you in writing > > in 30 > > > days, so you can harass them if you have not heard. Your doctor > can > > > start calling them telling them your therapy is in jeopardy, etc. > > > > > > 5. Remember that the doctor's office is not the enemy...they deal > > with > > > the ins. companies daily. I find that having proof of delivery > cuts > > > down on the claims of " it never got here " . > > > > > > Employees of these companies are not well paid and it shows...I > had > > > one say it was too far to walk to the other end of a building to > > see > > > if a fax had come in and I would have to wait until it came to her > > > desk via inter office mail! (Cigna if anyone wants to know) > > > > > > Mostly, send every bit of documentation you have, and keep > detailed > > > records of every contact you have. The authorization process > > consists > > > of clerks with a check list to go through...if something is > missing > > > from the checklist, they kick it back. No doctor or nurse ever > > sees it > > > until the whole package is together. > > > > > > Happy re-authorizing! > > > > > > P. Quote Link to comment Share on other sites More sharing options...
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