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When you hear the words “prior authorization,” here’s what to know.
For some medications, your doctor may need to get approval from your insurance provider before the prescription can be filled. This is also known as a “prior authorization.”
Without this approval, your insurance plan may not pay for your medication.
Why do some medications or procedures require prior authorization?
Health insurance companies have long used prior authorization as a way to control their costs. Without prior authorization, your insurance plan may not pay for your medication, and you would be responsible for the full cost.
What is prior authorization?
Prior authorization (also called “preapproval” or “precertification”) is what your health insurance company sometimes requires in order to approve coverage for certain medications or procedures before they are prescribed. It’s essentially your healthcare provider claiming that the care they prescribed is medically necessary.
What happens if my prior authorization request is denied?
Don’t worry, you have options. Sometimes even simple clerical errors can affect a request. So, the first best step is to find out why. Your healthcare provider should be able to help. You and your provider may choose to appeal the decision if you think the denial was not justified.
How long does the prior authorization process take?
Currently, prior authorizations are processed within 5 to 10 days. For some medications, it can take up to 30 days. For urgent requests, prior authorizations can be processed within 72 hours.
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From co-pay cards to help navigating insurance approvals, we’ll guide you to the right support. And if you’re eligible for our programs, we’ll help you get the Pfizer medicines you need.
Frequently asked questions
What are some common symptoms of ATTR-CM?
In addition to heart failure, carpal tunnel, stomach issues, lumbar spine stenosis, peripheral neuropathy, and others.
Why is ATTR-CM sometimes underdiagnosed or misdiagnosed?
Awareness among patients, and even physicians, remains low, which results in ATTR-CM being significantly underdiagnosed. Underdiagnosis and delayed diagnosis occur because the symptoms of ATTR-CM mimic those of other more common causes of heart failure.
Why is it important to speak with a doctor if you have a family history of heart failure?
Because the hereditary type of ATTR-CM is passed to family members.