Medication and Insurance Authorization
If your child's prescriptions require monthly amounts or must be written as a 90-day supply, please notify our office during your visit. If you are unsure of your medication plan, you can get information by calling the number on the back of your insurance card. As insurance coverage varies, please note that your insurance company may only cover a specific brand of insulin, oral hyperglycemic agent, blood glucose monitor and the number of strips. To learn more about what is covered, please contact your insurance company directly.
Prescription refills are not considered a medical emergency and will not be called in after office hours. Please be aware that refills will not be called in if we have not seen your child in the past six months. If prescribed medications or supplies are not covered by your insurance plan, it is your responsibility to draft a letter of medical necessity with the name of the insured, identification number, address, telephone number, the name of the medication and supply, amount and schedule.
Many patients require medical equipment for blood glucose monitoring or insulin delivery systems. Consult your insurance company its list of selected providers, durable medical suppliers and pharmacies. Again, note that your insurance company may only cover specific blood glucose monitors, number of strips, insulin pumps and insulin. Please contact your insurance company directly with specific questions about what is covered.
You need a prior authorization if the pharmacy tells you that in order to get the amount of strips required per month (usually more than 200), or more than two (2) vials of insulin per month.
If a prior authorization is needed, the parent must contact their insurance company to find out the process. Please note the following points as it relates to obtaining a prior authorization:
- Many times the pharmacy or the insurance company can give the parent the contact number to call to start the prior authorization process
- The prior authorization process may also requirement for you to include "documentation of the use of the amount of strips." If this is the case, this can be provided by either logging of the blood sugars or downloads of the meter and/or pump
Once the parent(s) have the information and the documentation, they should contact the office to begin work on the prior authorization process.
The above information is not medical advice and is provided for information only. You should not make any treatment decisions on the basis of this information.