Frequently Asked Questions
Q: What is a Prior Authorization?
A: A Prior Authorizations is when your insurance reviews the clinical information for certain items to
determine medical necessity before we can deliver to you. The requirements do vary among insurances and
what products require a PA.
Q: How long does it take to get a prior authorization?
A: Once the insurance receives our application, they have 15 business days to make a decision. Feel free to
send us an e-mail (firstname.lastname@example.org) to check the status.
Q: What if the request was denied?
A: .You have the right to appeal the decision to your insurance company by following the instructions given on your Decision Notice from the insurance company. We will notify the prescriber and the patient to advise them of the denial reason, and what the insurance company is requiring in order to get an approval.
Q: How long is my authorization good for?
A: We apply for the full length of time that the doctor prescribes, however the insurance may choose to modify/approve a shorter length of time or a lesser quantity based on their review of the documentation. Please note, the insurance company will not approve the authorization for more than a one (1) year time period. Once the authorization is received, we will let you know exactly the length of time the authorization is approved.
Q: Once the authorization comes in, what happens next?
A: We will contact the patient to let them know of the approval and when we can set up a delivery. At that
time we will also describe the monthly reorder process.
Q: What if insurance changes while my Prior Authorization is still pending?
A: If there is a change of insurance, please notify us immediately. In almost all cases we will have to request a
new authorization, which means contacting the doctor’s office to start a new request
Q: What if I no longer need the supplies that are prescribed?
A: Please call us to let us know that you would no longer like to receive those items. If you need a different item, we will need to apply for a new prior authorization for the new item. This will require a new request from the doctor’s office.
Q: How soon should a new authorization be requested before the current authorization expires?
A: We have a process to notify the doctor and recipient one month before expiration date. At that time we
also place a call to the patient to advise them of the upcoming expiration. We have found that this is plenty of
time to get all the correct documentation and get a new authorization before the current one expires.
Q: How often are orders sent to the Patient?
Orders can be placed once a month. We have a system that will automatically call you when you are due for an order. At that time, you must leave a message or call us back to place an order. Please allow 2-4 business days for the delivery. You can place your order by calling 508-865- 4857 then choose option 2, using our online order form or by emailing us at Orders@allcaremed.org.