What is Prior Authorization?
Some medications, tests, or treatments require something called prior authorization (PA) before your insurance will agree to cover the cost. This means that your insurance company wants to make sure the treatment is medically necessary before they approve payment.
What’s the Process?
At Physicians Premiere Weight & Wellness Center, we take care of submitting the prior authorization request on your behalf. Here’s how it works:
- Your provider recommends a treatment or medication (like Wegovy or Zepbound).
- A prescription is sent to your pharmacy.
- The pharmacist will initiate the PA and send it to us.
- We will complete it and send a request to your insurance company with medical documentation showing why it’s needed.
- Your insurance company reviews the request, which usually takes 3–5 business days.
- You’ll be notified once it’s approved or denied. If denied, we can sometimes file an appeal or explore other options.
What You Can Do to Help
To speed up the process, we recommend:
- Calling the number on the back of your insurance card to ask if your plan covers the recommended medication or test.
- Asking whether your employer has opted in for weight loss medication coverage.
- Finding out what your copay or out-of-pocket costs may be if it is approved.
Need Help?
We’re here to guide you through the process and answer any questions along the way. If your medication or test requires prior authorization, we’ll do everything we can to help you get the care you need as smoothly as possible.