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April 20, 2017 | by The Polyclinic

We’ve teamed up with Connexion Insurance Solutions to provide you answers to some of the frequently-asked-questions patients ask about Medicare. Each month we’ll publish an article or series of questions that are commonly asked about Medicare.

What’s the difference between a “Prior Authorization” and “Referral”?

A. Prior authorization refers to obtaining permission from your insurance company for specific procedures, services or medications. A referral references documentation needed for a provider sending a patient to another provider, like a family doctor to a specialist.

Why are some prescription drug plans requiring longer prior authorization wait times?

A.The process of prior authorization can require exhaustive due diligence in order to grant or deny prescription drug coverage. Capacity varies among prescription drug plan companies, which can impact prior authorization wait times.

Connexion Insurance Solutions

Reference: Source: Medicare Prescription Drug Benefit Manual Chapter 6




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