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Urinalysis
A urinalysis is a test of your urine. A urinalysis is used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes.
Why it's done
Definition
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To review your overall health
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To diagnose a medical condition
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To monitor a medical condition
Fasting?
No
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only if done by itself
Mission Trail
Montclair
Temecula
Created by
Alonso Zamorano
Tel: 855-505-7467
Prior Authorizations
It is a request submitted by the prescribing physician to the insurance whenever a medication or service is not covered by the patient's plan.
The physician justifies the need for this specific medication or service and then it is up to the patient's insurance whether to approve or deny it.
What is it?
Now, to better understand this
let me give you guys an example which I will divide in 5 steps
1
Consultation
Michael is a 35 year old patient who went to his doctor's appointment for severe pain and he was prescribed Norcox due to this issue.
2
Pharmacy
Upon going to his neighborhood pharmacy, Michael is told by the pharmacist that the prescription will not go through without a “prior authorization.” Due to the fact is not covered by his insurance.
Michael Does not know what this means and said, “If the doctor wrote me a prescription for a medication I need, then the insurance company should pay for it and the pharmacy should fill it.”
!
Notice
Prior authorization (PA) is a requirement that the physician obtain approval from the health insurance plan to prescribe a specific medication for the patient. PA is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company.
Without this PA, the insurance plan may not pay for the medication. Even then, the insurance company – not the doctor – has the final say in the matter.
3
What now?
What should Michael do now that the pharmacist told him that Norcox requires a Prior Auth? Generally, the pharmacy will contact the doctor who prescribed the medicine and let him know that Michael's medicine requires a Prior Authorization.
4
Notifying the clinic
Here´s when either the pharmacy or the patient will call to inform us about the prior authorization and sometimes the patient would only say “The insurance does not want to covered my medication ”
Now is your duty to contact the appropriate clinic to let them know about the request in order for them to process it.
5
Processing the Prior Auth
Once the person in charge submit the prior authorization request, Michael should be informed that the insurance company will take some time to complete their end of the process; this typically takes days, not hours.
Then, Michael should check back with the pharmacy within a week to see if Prior Auth was approved. If his medicine was not approved, Michael should call his insurance company to find out why or the provider will look for an alternative.
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