Prior Authorization
A prior authorization is when insurance refuses to pay for a medication until they receive an in-depth justification from your prescriber.
Please read all of these carefully! Check off as you read to progress.
Sorry you got hit with this! Prior authorizations are a hassle for all parties involved. We'll try to move you through this as painlessly and quickly as possible.
Insurance companies often take time to process requests. They sometimes lose our requests without letting us know, which can create delays.
Gmail filters/hides our emails to you (including in response to this PA request). If you ever leave us a voice mail, we will email you back after attempting to call.
To reveal our email in Gmail: Search your email for Ann Arbor Psych to reveal our email responses. If we need to, we'll respond to this by email.
Requests for medication renewals are done only through our webform on AnnArborPsych.com. (Don't leave a voicemail). AnnArborPsych.com: Click "Prescription Requests" and the request will go directly to the prescriber's inbox, bypassing clerical staff entirely and speeding the process considerably.
We are unable to respond to automated pharmacy requests for medication renewals due to the large volume of inaccurate requests. Always use the web form on AnnArborPsych.com! :)
Prior Authorizations come with a paperwork free. We reduced the customary $20 per page charge to $10 for an entire Prior Authorization submission. No charge if we are ever delayed by more than 5 business days, though these are generally turned around in 24 business hours.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What medication needs a Prior Authorization?
Date of Birth
-
Month
-
Day
Year
Date
Current Date
-
Month
-
Day
Year
Date
Are you currently taking this medication or is it a new medication?
I am currently taking this medication
This is a new medication I'm starting or restarting
Have you failed trials of similar medications? If so, what dates were they tried and why did they not work?
If you can't remember precise dates, give us your best guess of the date! Even if you expect the information is in our records, BE COMPREHENSIVE and make your best guesses on specific month/year dates.
Important to avoid delays: Could you please provide a picture of your Prescription Coverage card? This is a separate card from your insurance card. If you do not have a prescription coverage card, please list your pharmacy and their phone number so we can call for information. If you have submitted a PA request this year and you have already sent us a picture of your Prescription Coverage card, please note down that we already have a picture of your card.
Information we need from prescription card: Plan name, cardholder ID (could also be contract number or member number) PBM name, BIN number, PCN number (need ALL of this!)
Prescription Card Front
Prescription Card Back
Submit
Should be Empty: