#Priorauthorization

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#Priorauthorization Reel by @the.np.mom - What do you think? I love being a nurse practitioner because I get to genuinely help people in ways that change their day-to-day life. I see patients
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@the.np.mom
What do you think? I love being a nurse practitioner because I get to genuinely help people in ways that change their day-to-day life. I see patients who’ve been stuck in limbo - having a hard time getting a medication they need, or struggling for weeks (sometimes months) to get in with a specialist - and I get to be the person who helps move things forward. There’s something really meaningful about being able to cut through barriers. When I’m able to sort out a prior authorization, find the right workaround, or make a referral actually go through, it’s not just “paperwork.” It’s relief. It’s a patient finally getting what they’ve been trying so hard to access. That’s why becoming, and being, an NP is so worth it to me. I’m not only treating symptoms. I’m advocating, coordinating, and making care happen. I get to have real impact on my patients, and I love knowing that what I do can make a difficult situation feel manageable again. Second clip from @aanp_news
#Priorauthorization Reel by @drgarthdavis (verified account) - It is sad that it takes an assassination for us to start talking about the problems with health insurance in this country, but we do need to have this
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@drgarthdavis
It is sad that it takes an assassination for us to start talking about the problems with health insurance in this country, but we do need to have this discussion. Health insurance companies used to be non profit entities but became for profit, and that changed everything. These companies make huge amounts of money. Their CEO’s make between 13 and 22 million, sometimes more. And they are incentivized to continuously make more, which means they are incentivized to spend as little as possible. Now look, we do need some control of our healthcare spending, but that control should not come from unqualified people whose sole job is to minimize expenditure. It is a real conflict of interest. In this video, I am just giving you some examples. Often times I have to call medical directors for health insurance companies to explain why I need a certain procedure or medication covered and they will find anyway they can to deny it. Often times I find myself speaking to a physician who may be a family practice doctor and has no knowledge about the procedure we are discussing. I find that they are often looking for any technicality to give a denial. One thing I have gotten from all these conversations is that they definitely do not have the patient’s interests in mind. What has been crazy lately is that they have been blaming the doctor for denials. For instance, they may cover a weight loss medication, but only under a very specific set of circumstances. When I write a weight loss medication, we need to get prior authorization. That means I write a medication and then the pharmacy has to call the insurance company and the insurance company says we need to make sure that the doctor really wants this medication and has a reason for prescribing this medication. So then I have to send them information and if they can find any reason to deny, they will. The patient may call the insurance company and the insurance company then blames the doctor instead of explaining their rules and regulations.
#Priorauthorization Reel by @softnurseshift (verified account) - I don't talk about this enough, but I've been working from home as an LPN for almost 10 years now. Not all at once. Not overnight. And definitely not
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@softnurseshift
I don’t talk about this enough, but I’ve been working from home as an LPN for almost 10 years now. Not all at once. Not overnight. And definitely not because I had some “perfect” background. 👇🏽 comment “REMOTE” if you want to learn how I’ve landed remote nursing jobs over and over again Here are the remote nursing jobs I’ve actually worked as a Licensed Practical Nurse 👇🏽 👩🏽‍💻Transitional Case Manager Worked with LTACHs, SNFs, inpatient rehab, and hospice across MI + IL Lots of care coordination, discharge planning, and communication between facilities 👩🏽‍💻Concurrent Review Nurse Reviewed charts for medical necessity in LTACHs, SNFs, and inpatient rehab Yes... as an LPN 🤱🏽SAHM season I stepped away from nursing for 3.5 years to stay home with my babies (I have 3 under 7) This matters because breaks do NOT disqualify you 👩🏽‍💻HEDIS Research & Abstraction Nurse Chart reviews, no phone, quality measures, data abstraction 👩🏽‍💻Clinical Review Nurse (Home Health) Reviewed documentation, services, and compliance 👩🏽‍💻Clinical Review Nurse (Prior Authorization) Medical necessity reviews, guideline-based decisions, zero bedside stress And here’s the part people always assume is “more” than it was… 👉🏽 I only had 1.5 years of SNF/LTC bedside experience when I went remote. That’s it. No ICU. No case management certification. No special connections. What I did have: ✔️ A license ✔️ Transferable skills ✔️ A resume that spoke the language of remote roles ✔️ And a strategy for where to apply (because applying everywhere is not the move) Remote nursing isn’t one job. And it’s definitely not “RN only.” LPNs belong here too, you just have to know how to position yourself and which roles are actually realistic. If you want to learn how I’ve landed remote nursing jobs over and over again, 👇🏽 comment “REMOTE” and I’ll point you in the right direction.
#Priorauthorization Reel by @lisa.remillard (verified account) - Have you ever needed an MRI or needed to see a specialist? If so, you've probably had to wait for a prior authorization from your insurance company in
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@lisa.remillard
Have you ever needed an MRI or needed to see a specialist? If so, you’ve probably had to wait for a prior authorization from your insurance company in order to have that service or office visit covered. Well, now the federal government is stepping in and revamping the prior authorization practice. This video will explain what was announced and how it will eventually impact you. #healthinsurance #healthcare #priorauthorization
#Priorauthorization Reel by @milesformigraine - When the pharmacy says it's not approved yet…😵‍💫 If you've ever stood at the pharmacy counter confused, frustrated, or ready to scream-this one's f
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@milesformigraine
When the pharmacy says it’s not approved yet…😵‍💫 If you’ve ever stood at the pharmacy counter confused, frustrated, or ready to scream—this one’s for you. Prior Authorization can feel impossible… but it doesn’t have to be. Join our Navigating Prior Authorization With Confidence webinar on 2/22 to learn: • Why denials happen. • What steps to take next. • How to advocate for the treatment your provider prescribed You’re not alone, and you do have options. Sign up to learn more and take back control!
#Priorauthorization Reel by @whitney.the.dietitian (verified account) - Nothing humbles you like a prior authorization. Insurance will cover 90% of complications of obesity… but not always the treatment. Make it make se
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@whitney.the.dietitian
Nothing humbles you like a prior authorization. Insurance will cover 90% of complications of obesity… but not always the treatment. Make it make sense. If you’ve ever fought a prior authorization, you get it.
#Priorauthorization Reel by @nurse_brian_plaintalkhealth - Healthcare navigation tip fromna nurse: If your parent's specialist says they "never received the referral," this is a care coordination problem - not
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@nurse_brian_plaintalkhealth
Healthcare navigation tip fromna nurse: If your parent’s specialist says they “never received the referral,” this is a care coordination problem — not bad luck. Learn how medical referrals actually move between primary care clinics, insurance authorization, and specialist offices — and the exact words to use to track them. Caregiver advocacy tip for: Referral delays Prior authorization tracking Insurance approval status Specialist scheduling problems Healthcare navigation for aging parents Keyword Block: medical referral process, prior authorization, specialist referral delay, caregiver advocacy tips, healthcare navigation, insurance approval tracking, primary care referral system #caregivers #caregivinglife #agingparents #elderlycare #medicare
#Priorauthorization Reel by @aaronthesocialworker (verified account) - She Died Waiting for Prior Authorization. So she passed away from stage four cancer." Silence. "Yeah, this is Aaron from social work." You're calli
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@aaronthesocialworker
She Died Waiting for Prior Authorization. So she passed away from stage four cancer.” Silence. “Yeah, this is Aaron from social work.” You’re calling about a patient satisfaction survey? On claim ending 3344? She died last week. Your prior authorization took three weeks. Three. Weeks. Stage four cancer doesn’t wait for utilization review. Her oncologist ordered the scans. Her oncologist ordered the chemo. Her oncologist documented medical necessity. Your PA delay meant no timely imaging. No timely treatment. No fighting chance. And now you’re asking how satisfied she was? I’m looking at the denial letter right now: “Services not medically necessary.” Not medically necessary? For stage four cancer? You had every lab. Every note. Every pathology report. But somehow a reviewer who never met her overruled the physician who was trying to save her life. This is the part no one wants to say out loud: When prior authorization delays cancer treatment, people die. And then the system moves on to the next claim number. I’m not sharing this for outrage clicks. I’m sharing this because families deserve to know what’s happening behind the scenes. If you or someone you love is fighting a denial for cancer treatment: • Appeal immediately • Request expedited review • Ask for peer-to-peer review • Document everything Because the clock is not theoretical. It’s real. And sometimes, it runs out.
#Priorauthorization Reel by @drmakkani (verified account) - Some "choices" in healthcare aren't really choices-they're contractual preferences dressed up as medical guidance. When your plan "prefers" a differen
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@drmakkani
Some "choices" in healthcare aren't really choices—they're contractual preferences dressed up as medical guidance. When your plan "prefers" a different medication, ask: Is this medical... or contractual? What criteria approve my doctor's prescription? What's the step-therapy timeline? Because if the system optimizes for profit, it will. One word: what do you think of when you hear "prior authorization"? #healthinsurance #PBM #healthbenefits #priorauthorization
#Priorauthorization Reel by @pancreaticcancerconqueror - There is now an FDA-approved wearable treatment option for pancreatic cancer, Optune Pax. This device was tested in humans and shown to extend surviva
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@pancreaticcancerconqueror
There is now an FDA-approved wearable treatment option for pancreatic cancer, Optune Pax. This device was tested in humans and shown to extend survival when used alongside chemotherapy — a meaningful step forward in a disease that has seen very few breakthroughs. But here’s the truth: FDA approval does not automatically guarantee insurance coverage. If you or someone you love is battling pancreatic cancer, talk to your oncologist and contact your insurance provider to ask about eligibility and prior authorization. Progress matters. Advocacy still matters. Stay informed. 💜 Heres the link- https://www.fda.gov/news-events/press-announcements/fda-approves-first-its-kind-device-treat-pancreatic-cancer #PancreaticCancer #breakthrough #cancer #progress #fyp
#Priorauthorization Reel by @kffhealthnews (verified account) - Prior authorization is a common tool used by health insurers for many tests, procedures, and prescriptions. Frustrated by the process, patients and do
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@kffhealthnews
Prior authorization is a common tool used by health insurers for many tests, procedures, and prescriptions. Frustrated by the process, patients and doctors have turned to social media to publicly shame insurance companies and elevate their denials for further review. Lauren Sausser explains more. Video produced by Hannah Norman

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