Get & Solostar Prior Authorization Request Form Member ...

If your prescription does require Prior Authorization or Step Therapy, please download and have your prescribing doctor or other prescriber complete a Coverage Determination Request Form (PDF). You can fax the completed form to us at 1-855-633-7673.

Health care providers usually initiate the prior authorization request from your insurance company for you. However, it is your responsibility to make sure that you have prior authorization before receiving certain health care procedures, services and prescriptions.

Most payer-physician contracts prohibit charging such fees, but if the patient is out-of-network they (the physician) have no contractual relationship with the plan. ... Some specialists try to avoid prior authorizations by referring the patient back to the PCP to obtain a prior authorization.

Call your physician and ensure they have received a call from the pharmacy. Ask the physician (or his staff) how long it will take them to fill out the necessary forms. Call your insurance company and see if they need you to fill out any forms.

Prior authorization is designed to help prevent you from being prescribed medications you may not need, those that could interact dangerously with others you may be taking, or those that are potentially addictive. It's also a way for your health insurance company to manage costs for otherwise expensive medications.

Through Medicaid services, a referral is issued in writing by your primary care physician when he or she feels it is necessary for you to visit another health care provider for treatment or tests. A prior authorization for this referral is necessary in some cases.

Traditional Medicare, in contrast, does not require prior authorization for the vast majority of services, except under limited circumstances, although some think expanding use of prior authorization could help traditional Medicare reduce inappropriate service use and related costs.

You can also telephone your Medicare Part D prescription drug plan's Member Services department and ask them to mail you a Prior Authorization form. The toll-free telephone number for your plan's Member Services department is found on your Member ID card and most of your plan's printed information.

Insurance companies can deny a request for prior authorization for reasons such as: The doctor or pharmacist didn't complete the steps necessary. Filling the wrong paperwork or missing information such as service code or date of birth. The physician's office neglected to contact the insurance company due to lack of ...