Prior authorization is getting permission from your insurance company before costs for certain medical treatments or medications are covered. Not all insurance plans or medications require prior authorization; in fact, many will not.
If prior authorization is required, your FOLX Care Team will work with your insurance plan to provide the information that is needed for approval. Once the prior authorization form is completed and submitted, usually within 24 hours of receiving the request, your health insurance company will take up to 14 days to make a decision. This review period varies and can be shorter or longer than the 14 day period.
If your request is approved, your insurance will help pay for the treatment or medication. You might still need to pay a portion, which is called a copayment (copay) or coinsurance. If your request is denied, your care team will work to appeal the decision with your insurance for you. If we are successful in the appeal, then your plan will help cover some or all of the cost of the medication. If we are still not able and the request is denied after appeal, this means that your insurance won't cover the cost, and you might have to explore other options with your healthcare provider.
Please send a message to your care team via the Athena Patient Portal if you need support with a Prior Authorization. Please include the below details to help expedite your request:
- Your insurance provider name, member number, and group number are on the front of your insurance card.
- The provider service number and address are located on the back of the card.
- Pharmacy name, address, and phone number
- Have you ever tried similar medications in the past? If yes, then the name of the medication, dose, route, and when it was prescribed. Please include any adverse or unpleasant reactions you may have had.
Once we receive this information, we begin the request.