Navigating the Prior Approval Process

What is the Prior Approval Process? There are certain items that require prior authorization through your insurance company before the item can be provided to you.

Here at AllCare Medical Supply, we specialize in knowing what is required by your insurance so that we can work with your doctor’s office to get you what you need.

It begins with the doctor.  Once clinical documentation is sent to us via Fax, email, dropped off at our office, or mailed through the U.S. Postal Service, our staff reviews it to see that it meets the insurance company’s criteria.  If it does not, we contact the doctor’s office to ask for the additional documentation needed.

Once we have the documentation, we will apply directly to your insurance. The insurance company will then review the application and respond with one of the four following decisions.

The insurance company will then review the application and respond with one of the four following decisions.

Approve: This means that your request has been fully approved. When you are approved, we will contact you directly to set up a delivery.

Modify: This is an approval, however, it is often a change from the original requested quantity and/or length of time to the insurance company’s modified approval of the quantity or length of time. We will contact you to discuss that and set up a delivery as well.  If needed, we will contact your doctor to re-apply for the requested amount.

Deferred: This happens when your insurance company is looking for more information about your application.  We will request the missing information from your doctor’s office so we can answer the insurance company’s request.

Denied: If the request is denied, we will contact you to let you know and the doctor’s office to let them know why it was denied so they can send additional documentation for a re-application.

Regardless of the decision, you will get a notice in the mail of their action on the request.

 

Insurance We Accept