Transcript
Speaker 1 (00:07):
Insurance rules and regulations have become ever more difficult. Just the other day I was telling my MA that I didn't think the insurance process could get any worse, and then it did. Everything we prescribe, virtually everything we prescribe, we're having to fight for. There are a couple of tips.
(00:25):
Number one, make sure your documentation is in check. So if you're prescribing something for atopic dermatitis, make sure your note says atopic dermatitis and not nummular eczema and not dyshidrotic eczema, and not just eczema. Make sure it says atopic dermatitis because that's the official condition that these drugs are indicated for. Make sure you're putting a BSA and that you're giving an IGA score of moderate or severe because that's what a lot of these systemic agents are approved for. If you're going for a topical, make sure it says mild or moderate.
(00:56):
Make sure all of that information is in there, list your tried-and-faileds so you're giving your prior auth specialist every tool that they need for a successful approval. If it's denied, appeal. If that's denied, consider a peer-to-peer review. If that's denied, consider an external review, external appeal. If that's denied, consider asking to speak to a medical director at the insurance company, reach out to your contacts in your local medical associations for your state or city, and you can always consider filing a complaint with the Department of Insurance for your state. We have steps that we can take to help ensure that our patients are getting the best treatment and we should not let insurance companies tell us what to do.
