Please give me the good and bad about prior authorization

Posted
by starmickey03 starmickey03, MSN, RN Member Nurse

Has 10 years experience.

Received offer for a prior auth position at a major insurance plan. What’s a day like? Something was mentioned about being on the phone queue- sounds awful. Does this position lack autonomy? How long does one auth take to complete usually? I haven’t been able to find much info about this position online and all my insurance experience has been CM which is extremely flexible and not micromanaged. Scared of making the wrong choice. 

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 6 years experience. 2,067 Posts

Hmm.

All I know is that prior authorization is a BS thing perpetuated by insurance companies to avoid paying for treatment and that it keeps patients from getting their meds on time or at all, especially vulnerable people like psych patients and elderly patients and that it contributes to the general brokenness of the American healthcare delivery system. 

But I’m crusty.

NutmeggeRN, BSN

Specializes in kids. Has 39 years experience. 8 Articles; 4,526 Posts

On 3/21/2022 at 9:18 AM, FolksBtrippin said:

Hmm.

All I know is that prior authorization is a BS thing perpetuated by insurance companies to avoid paying for treatment and that it keeps patients from getting their meds on time or at all, especially vulnerable people like psych patients and elderly patients and that it contributes to the general brokenness of the American healthcare delivery system. 

But I’m crusty.

Yup, fail multiple meds...(and be miserable the whole time totally discounting what your provider is seeing in front of them) and then you can have what you need.

traumaRUs

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 30 years experience. 164 Articles; 21,155 Posts

I'm an APRN and am on the requesting end of prior auths. It's got to be a miserable job IMHO. I'm on hold up to one hour depending on what insurance company I'm calling. I always have to speak to a clerical person first and then if I'm lucky I get to hold again for the RN. We now use CoverMyMeds for many prior auths for meds and that is so much better. However, prior auths for CT, MRI are brutal because they have to be done on the phone.