How to re-authorize

[Guest guest]

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.