TLDR; Medicaid managed care plan, out-of-network provider is prescribing a different medication because the first one required prior-authorization, but the new one also requires it. Is there a reason my provider can’t authorize the medication they prescribed? Does the provider need to be in-network?
I have a medicaid managed care plan and my doctor is out-of-network. The first mediation they prescribed required prior authorization and when I reached out to the doctor they said they would look into it but might need to prescribe an alternative. So they prescribed an alternative and it also requires prior-authorization. I’m pretty desperate to start this medication and its been more than a week since the first prescription, so I called the pharmacy to see what I could do. The pharmacist was very nice and said that she spoke to my doctor the first time and the doctor asked if any medications in this category didn’t require prior-authorization and she said no, they all do, and apparently he hung up on her and put in the second prescription. The pharmacist also said that the authorization with medicaid only takes 20 minutes. What is going on here? Is my provider unable to provide authorization or do they just not want to? I’m just about ready to pay out of pocket, this is driving me insane.
submitted by /u/ChinchillaToast
[link] [comments]TLDR; Medicaid managed care plan, out-of-network provider is prescribing a different medication because the first one required prior-authorization, but the new one also requires it. Is there a reason my provider can’t authorize the medication they prescribed? Does the provider need to be in-network? I have a medicaid managed care plan and my doctor is out-of-network. The first mediation they prescribed required prior authorization and when I reached out to the doctor they said they would look into it but might need to prescribe an alternative. So they prescribed an alternative and it also requires prior-authorization. I’m pretty desperate to start this medication and its been more than a week since the first prescription, so I called the pharmacy to see what I could do. The pharmacist was very nice and said that she spoke to my doctor the first time and the doctor asked if any medications in this category didn’t require prior-authorization and she said no, they all do, and apparently he hung up on her and put in the second prescription. The pharmacist also said that the authorization with medicaid only takes 20 minutes. What is going on here? Is my provider unable to provide authorization or do they just not want to? I’m just about ready to pay out of pocket, this is driving me insane. submitted by /u/ChinchillaToast [link] [comments]Read Morer/HealthInsurance