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Docs on Call - Battle between medicine and insurance

Should insurers have a say in what kind of medicine you receive?  They do, through a practice called 'prior authorization'. 

It's not always easy to get your insurance company to pay for what your doctor orders, especially when it comes to more expensive medications and procedures.  It means the insurance company must agree to pay before you can receive what the doctor orders.  

Prior authorization is usually done one of two ways:  a 'soft' process where your doctor's plan is simply approved by a specialist or the hard way, where established criteria is also matched against what the doctor and the specialist have decided.

Insurers insist that prior authorization saves money, prevents waste, and holds down your health insurance costs.  But, doctors say that the time spent waiting for prescriptions to be approved can make a situation worse, and wonder how much say insurers should have in making your health care decisions.


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