Prior-authorizations can be a time-intensive process, often required between the time that a treatment is prescribed by your doctor before it can be administered or accessed (1). For most insurance companies, even if a drug was newly prescribed and administered in December, a new prior-authorization will need to be submitted January 1st of the new year (2).
Below are 3 steps to implement before the new year to avoid any delay in your care.
- Find a trusted GI team.
This is a loaded suggestion considering that “find” often requires:
- Time spent searching for a new provider and/or time spent searching for a new doctor
- A referral from another doctor, often requiring an in-person appointment
- Checking to see if the new, prospective doctor is considered in-network by your insurance provider
- Transportation costs for a commute
I’ve been fortunate to have experiences that helped me feel supported by a GI team, and I’ll share these with you:
- My doctor believes me. They ask questions, offer solutions, or coordinate care with other providers when needed, instead of normalizing my experience or saying, “the research doesn’t support that” in response to my question or complaint.
- My GI doctor’s staff is communicative. This can be hard when there are ever-present systemic challenges, but when I know that my doctor’s medical assistant, insurance liaison, or a PA is communicating with insurance on my behalf so I can access prescribed treatments faster, that matters to me. Big bonus points if I can get a heads-up on when to anticipate insurance approval.
- My GI doctor’s staff is helpful. When I call with a concern, they follow-up with a plan, a suggestion or a solution. If I’m unable to access a prescribed treatment, they do what they can to make sure that it’s accessible as soon as possible, and that makes me feel like alerting them when there’s a problem isn’t too much; it’s not a burden, and they can handle my disease with me.
- TLDR: My doctor trusts me to trust my body’s cues, and everyone on my doctor’s staff, from receptionist to administrator to PA, knows that they play an integral and crucial role in my care
Things to consider:
What kind of support have you not been receiving that hinders the quality of care provided to you? What makes you feel supported? Ask people with IBD if how they have been able to find providers who support them, and use their word-of-mouth referrals to find a provider if you can!
- Ask your GI team if you need to get any tests done before the beginning of the year.
Some medications require chest x-rays, certain blood panels, or vaccines before insurance will agree to cover them. To avoid delaying access to your prescribed medications, ask your doctor if these need to be done before the new year (2). If you’ve already hit your out-of-pocket maximum with your insurance company, it might be a good idea to ask if costly disease-monitoring tests, like colonoscopies, or MRIs are needed.
- Ask for nutrition-related labs and/or a referral to see a GI or IBD Dietitian.
If there are symptoms that you have normalized and accepted as part of the disease, such as fatigue, or your hair falling out, it’s important to note that these are also symptoms of anemia, and 60-80% of people with IBD are navigating anemia on top of their existing IBD diagnosis (3). Ask your doctor for a “total iron binding capacity with ferritin” lab draw (this will be 2 vials) and a referral to see an IBD or GI dietitian who can help you optimize your nutrition no matter what phase of IBD you are navigating. In the nutrition world, we dietitians pride ourselves on helping you recognize what your body is telling you and fix nutritional deficiencies before they are full-blown anemias. If you find that you are deficient now and in need of an iron infusion, this might take some time for insurance approval, and now is a good time correct a deficiency if you have reached your out-of-pocket maximum for the year so it will be affordable. Some iron-infusion manufacturers offer reimbursement programs, which might be worth exploring with the help of your GI doctor’s office.
Need more support? Feel free to schedule a complimentary consultation where we can discuss your nutrition-related goals and come up with a solution together.
- What is prior authorization? Cigna. https://www.cigna.com/knowledge-center/what-is-prior-authorization. Accessed October 24, 2022.
- 2021 prior authorization state law chart – American medical association. American Medical Association-Advocacy Resource Center. https://www.ama-assn.org/system/files/2021-04/pa-state-chart.pdf. Published 2021. Accessed October 24, 2022.
- Stein J, Dignass AU. Management of iron deficiency anemia in inflammatory bowel disease – a practical approach. Ann Gastroenterol. 2013;26(2):104-113.