Prescriptions/Prior Authorization
Prescriptions
Under practically no circumstances will the staff at Urologic Surgeons of Washingtons fill prescriptions over the phone. This is particularly true for those patients feeling as if they have an infection. In such a case, we will always be willing to have you come to one of our offices on the same day, be checked in as a formal appointment so that we may culture your urine, after which we will gladly give you either antibiotic samples or a prescription as your evaluation dictates. On the weekend, an urgent care facility or an emergency room must substitute for the source of a prescription and the performance of a urine culture.
If a patient has run out of their prescription, we will likewise invite you on whichever day you choose to one of our offices to be seen as an appointment, evaluated and re-prescribed your medication if appropriate. It is because of this policy that the doctors at Urologic Surgeons of Washington will always refill your recurring prescription during an appointment with refills for one year. Here, we feel the system is correct in forcing a patient to be re-evaluated as to the appropriateness of a medication once a year.
At times, insurance companies will systematically cancel one’s prescription after a set period even though we have prescribed a year’s supply of refills. In such a case, Urologic Surgeons of Washington will require that an appointment be made to renew the prescription as this policy is executed by the insurance company and not our office. In such a case, as is the case with antibiotic prescriptions or other refills, we will always try to accommodate your refill appointment as conveniently for you as possible, as we understand the frustrating nature of this insurance action.
Prior Authorization
Unfortunately, today’s insurance climate has led to pressure on private insurance companies to be much more restrictive than years past with regards to filling prescriptions that doctors prescribe. Within the field of Urology, there are several classes of drugs that although technically covered by an insurance plan will not be dispensed without going through a process called “prior authorization”. In essence, although your doctor has prescribed for you a medication with a legal document called a prescription, the “prior authorization” is an extra step that your insurance company places within the process. Although your pharmacy will imply that it is a simple matter, it is very time consuming in a way that to perform this becomes an almost impossible task to do in a busy physician’s office. As this process is a construct of the insurance company and not our office, Urologic Surgeons of Washington feels that the patients should partner with us in this matter.
Rather than simply refusing to do this for you because of the extra time involved, Dr. Engel will be happy to fulfill this “prior authorization” process with you in the office. If confronted with this, simply call our office and make a formal appointment to get it done. We promise to add you on to our schedule for whatever day you choose. We will have you make the call to your insurance company yourself in our exam room during a formal appointment, using the phone number on your insurance card, and when ready, either Dr. Engel or a staff member will answer one or two brief questions that will enable the process to be finished. In this way, both patient and doctor will be part of the process, and the patient will see that it is done and then can communicate directly with the insurance company themselves from that point forward. We will usually be able to give you samples of the medication you seek during that visit. As usually the medication that is being sought is an expensive medication, this process is often worth the hour it will cost the patient to go through it. Urologic Surgeons of Washington simply lets the patient weigh the cost of the hour in our office to the cost savings of completing the process and having the drug covered.
The Urologic medications that are classic for triggering this process are daily Cialis, erection medicines in general if there is any coverage for this at all, testosterone preparations, or any overactive bladder medication that is not a generic medication. All patients should be sure that their insurance company states that the medication they seek is covered before going through the “prior authorization” process so as not to waste time and effort.
