Would you like to switch to the accessible version of this site?

Go to accessible site Close modal window

Don't need the accessible version of this site?

Hide the accessibility button Close modal window
Accessibility View Close toolbar
Menu
  • Home
  • The Practice
    • Offices
    • Insurance
  • Our Services
    • Surgical Dermatology
    • Aesthetics
    • Cosmetic Dermatology
  • Our Providers
  • Patient Resources
    • Join Our Email List
    • Make a Payment
    • Patient Portal
    • AAD Resources
  • Skin Care Products
  • Contact Us
Dermatology Practice Logo

Grand Strand Dermatology, LLC

"Love The Skin You're In"

Visit our Patient Portal
Join our Email List
Make an Online Payment

9400 Frontage Road (Hwy 17 Bypass)

Murrell Inlet, SC 29576

(843) 215-1100

933 Medical Circle

Myrtle Beach, SC 29572

(843) 215-1100

843-215-1211

Check us out on Social Media

logo
  • Home >
  • Articles >
  • Pamphlets >
  • How to get prior authorization for medical care

How to get prior authorization for medical care

  • Created in Pamphlets

Have you ever tried to make an appointment to get a medical test, arrange for a treatment, or fill a prescription from your dermatologist only to find out that you need prior authorization?

When some patients hear these two words, they don’t know what to do next. The following explains what you need to know.

Your health insurance provider may require you to get prior authorization before you fill a prescription or get other medical care.

A pharmacist fulfilling a prescription pill bottle.

What is prior authorization?

Prior authorization, also called prior approval or pre-authorization, is a process that many health insurance companies, as well as Medicare and Medicaid, use to manage costs.

Before you can get coverage for certain medications, tests, procedures, surgeries, and medical devices, you need to get prior authorization. Without prior authorization, you may end up paying the entire cost or be denied the treatment.

Who needs to get prior authorization?

What requires prior authorization can vary from one insurance provider to another. It can also vary from plan to plan, year to year, or state to state.

For example, you may be treating a skin condition with a medication that isn’t working as well as you’d like. During your last dermatology appointment, your dermatologist wrote a prescription for a different medication. When you tried to fill the new prescription, your pharmacist told you that you need prior authorization, even though you never needed this for the other medication.

How long does it take to get prior authorization?

Insurance providers typically reply to a request for prior authorization within 30 business days, and many providers could reply sooner. For example, when dermatologists tracked how long it took patients at their practice to get a reply for prior authorization for a biologic medication, they found that about half of their patients had a reply in under 8 business days. Response time varied with the type of medication prescribed.1

Steps for getting prior authorization

While each insurance provider may use slightly different steps, here is what typically happens during the prior authorization process.

  1. Your dermatologist writes a prescription: After your prescription is sent to the pharmacy by your dermatologist or dropped off by you, the pharmacist will run the prescription through your insurance. Then, your insurance company will let either you or someone at your dermatologist’s office know if you need a prior authorization.

    What you need to know: What requires prior authorization varies from one health plan to another, so your dermatologist may be unaware that a prescription or test requires prior authorization under your plan. There are hundreds of medications and many health plans.

    Some health plans allow you to log in to your member account or patient portal to find out different options, such as whether your plan covers or partially covers your medication, the price, or any limits and requirements. If you learn that you need prior authorization, contact your dermatologist’s office as soon as possible. They have experience getting prior authorization.

  2. Your dermatologist’s office creates a request and submits the information required by your insurance provider for prior authorization.

    What you need to know: Your dermatologist’s office will let you know what is required of you when requesting prior authorization. You may only need to keep track of updates coming through the patient portal or wait for a call from your dermatologist on a decision.

  3. Your insurance provider informs your dermatologist’s office (or you) of its decision. If approved or denied, the following could happen:

    • Prior authorization approved: You can fill the prescription, begin the treatment, or schedule the testing that your dermatologist prescribed for you; or
    • Prior authorization denied: Someone in your dermatologist's office prepares the materials required to appeal this decision.

    What you need to know: Sometimes, the insurance provider tells only the patient of its decision. If your insurance provider contacts you, reach out to your dermatologist’s office to let them know the decision. If the insurance provider denies the request for prior authorization, you can appeal.

  4. If your initial request was denied: Here’s what happens next. Many people feel discouraged when they find out that the insurance provider denied the request for prior authorization. Don’t give up. You have the right to appeal this decision.

    Many patients who appeal eventually get approval. For example, dermatologists at one practice found that 64.6% of appeals to get insurance coverage for a prescription were approved.2

    What you need to know: You can help the appeal process run more smoothly by staying on top of any paperwork you get about prior authorization and staying in touch with your dermatologist’s office on your progress. In addition to your dermatologist writing an appeal letter for you, it is often helpful to write your own appeal letter to your health insurance to make it more personal.

When your medical care requires prior authorization

While your dermatologist (or practice staff member) will submit the request for prior authorization to your insurance provider, you can help by doing the following:

  1. Communicate quickly with your dermatologist’s office in a HIPAA-secured and private way: If your dermatologist has a patient portal, set up your account if you haven’t already done this.

  2. Avoid delays in your care: The AAD recommends after four business days, if you haven’t heard whether your insurance provider approved (or denied) the request for prior authorization, follow up with your dermatologist’s office and your insurance provider.

  3. Make sure you’re following your treatment plan: It can take time to get prior authorization. If your insurance provider approves the request for prior authorization, it can be helpful to log in to your patient portal to review your treatment plan before starting it.

Dermatologists help their patients get the care they need

Dealing with the prior authorization process can be frustrating, confusing, and overwhelming. Dermatologists understand this and work hard to ensure that their patients get the care they need.


Infographic: What is prior authorization?

This infographic shows the steps during the prior authorization process.

Prior authorization infographic for patients

Related AAD resources

  • I cannot afford my psoriasis medication! Now what?

  • Financial help for people who have skin cancer


Image
Getty Images

References
1Popatia S, Flood KS, et al. “Examining the prior authorization process, patient outcomes, and the impact of a pharmacy intervention: A single-center review.” J Am Acad Dermatol 2019;81:1308-18.

2Ibid.


Written by:
Swapna Bhatia, MPH
Michelle Pizarro, MHA

Reviewed by:
Sanna Ronkainen, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 2/3/21


All content solely developed by the American Academy of Dermatology
  • Acne and rosacea
    • Exercise and sports
    • Rosacea
    • Stubborn acne
    • Teenage acne
  • Bumps and growths
    • Moles
    • Birthmarks
    • Scars
  • Color problems
  • Contagious skin diseases
    • Cold sores
    • Genital herpes
  • Cosmetic treatments
    • Cellulite treatments
    • Laser treatment for scars
    • Liposuction
  • Dry / sweaty skin
  • Eczema / dermatitis
  • Hair and scalp problems
  • Itchy skin
  • Painful skin / joints
  • Rashes
  • Scaly skin
  • Skin cancer
    • Melanoma
  • Skin, hair, and nail care
    • Skin care
    • Hair care / hair loss
    • Injured skin
    • Nail care
    • Anti aging skin care
  • Other conditions
  • Videos
  • Pamphlets

Skin Cancer Removal Procedures

Skin Cancer patients can expect a surgical plan to remove their skin cancer based on the location , size, and type of tumor. Most treatments to remove cancerous lesions can be conducted under local anesthesia.

 

The Skin Cancer is removed with a Surgical tool called a curette with a hoop or scoop on the end for scraping. An electric current is then applied to the area through a needle-like electrode designed to kill the remaining cancer cells and reduce bleeding.

After care instructions: The ED&C site must be kept clean if it is to heal rapidly. It is a small open wound which may or may not leave a scar. To clean the site, follow these instructions

First Wash Your Hands With Soap and Water

1. Remove Initial dressing in 24 hours.

2. Wash the area with soap and water twice a day. Apply a thin film of Aquaphor or Vaseline and cover with a fresh bandage until healing has occurred. This may take up to 2/4 week, depending on size of the wound and location.

3. Do not use Neosporin or other over the counter topical antibiotics as allergies to these medications are quite common and they can slow down healing.

4. Keep wound moist with Vaseline and band-aid, as stated in number 2. A scab or leaving it open to the environment will slow down healing.

It is normal for the site to become puffy, reddened, or irritated. However, if the site is warm to the touch, oozing, or severely reddened or very sore, you need to contact the office at (843)215-1100.

 

The skin cancer growth is removed with surgical excision by cutting or shaving it out of the skin with a scalpel. Local anesthesia is used to numb the affected area. Depending on the type of tumor, our surgeons my remove a certain amount of surrounding tissue. 

After Care Instructions: First Wash Your Hands With Soap and Water

1. You may apply an ice pack following surgery. Apply the ice pack on for 20 minutes, and then remove for 20 minutes, and repeat the process as needed. 

2. Remember, applying direct pressure to the surgery site stops bleeding.

3. You may take Tylenol for Pain if needed.

4. Leave the wound dressing on for 24 hours

5. While showering, remove your current dressing and clean your wound, and the remove for gently with warm water and soap to remove any dried blood and prevent scab formation.

6. Apply Vaseline ointment at least one time daily, and cover the entire wound with a band-aide or gauze dressing.

7. On your scheduled day of suture removal, cleanse the wound, and leave the area DRY(do not apply any ointment) and return to our office at your scheduled time to have the sutures removed

8. If your wound is in the beard area on your face or other area where you normally shave, please avoid shaving near the wound.

9. If the surgical site starts to bleed excessively and doesn't stop with applied pressure for 15 minutes, the dressing become saturated with blood. If there is excessive swelling or the site become inflamed and warm to the touch. Call the office at 843-215-1100

 

The surgeon removes the visible skin cancer and come surrounding tissue via and incision. The removed tissue is frozen, dyed, and evaluated under a microscope by a pathologist to see if the cancer has been removed entirely. If cancerous cells are still present, the process of excision and evaluation is repeated until the cancer is no longer detected. The diagnosis of the removed tissue is made in real-time, so the patient can be confirmed cancer-free the same day. The process can take several hours to fulling remove the cancer.

After Care Instructions: First Wash Your Hands With Soap and Water

1. You may apply an ice pack following surgery. Apply the ice pack on for 20 minutes, and then remove for 20 minutes, and repeat the process as needed. 

2. Remember, applying direct pressure to the surgery site stops bleeding.

3. You may take Tylenol for Pain if needed.

4. Leave the wound dressing on for 24 hours

5. While showering, remove your current dressing and clean your wound, and the remove for gently with warm water and soap to remove any dried blood and prevent scab formation.

6. Apply Vaseline ointment at least one time daily, and cover the entire wound with a band-aide or gauze dressing.

7. On your scheduled day of suture removal, cleanse the wound, and leave the area DRY(do not apply any ointment) and return to our office at your scheduled time to have the sutures removed

8. If your wound is in the beard area on your face or other area where you normally shave, please avoid shaving near the wound.

9. If the surgical site starts to bleed excessively and doesn't stop with applied pressure for 15 minutes, the dressing become saturated with blood. If there is excessive swelling or the site become inflamed and warm to the touch. Call the office at 843-215-1100

 

Typically used to treat minor skin cancers and pre-cancerous lesions, cryosurgery involves the use of liquid nitrogen to freeze and destroy the cancer cells. The procedure, also known as cryotherapy is repeated until the affected area no longer shows signs of pre-cancer or cancer.

After Care Instructions: 

1. You do note need to cover the area treated, unless instructed to do so.

2. The discomfort is temporary but may last for 10-30 minutes after treatment.

3. the area may appear red for up to one hour after freezing but often returns to normal color within 10-15 minutes.

4. A blister may form within 24 hours of treatment. this may be clear fluid filled or blood filled, if it is uncomfortable, you may drain it by using a clean needle cleansed with alcohol. If this is done, cover with a Band-Aid and Vaseline ointment for approximately one week. This bandage should be changed daily. 

5. Sometimes a scab will will form over the area treated. This will come off on its own and does not need to be covered.

6. If you have any questions or concerns after reading the above information, please do not hesitate to call our office at 843-215-1100



Side Effects of Skin Cancer Removal 

With any kind of skin cancer removal, scarring is likely to occur. Incision sites may be sore, red, or drain small amounts of fluid. Healing will continue for weeks and even months after your surgery, incision lines will fade and continue to improve. Sun exposure on wounds and scar lines can result in irregular pigmentation or cause the sight to become red, raised, or dark, so patients should follow post-op preventative instructions carefully. 

Specials

vday lasers

20%off val

vday sepcial

Our Locations

Find us on the map

Hours of Operation

Our Regular Schedule

Monday:

8:00 AM-4:00 PM

Tuesday:

8:00 AM-4:00 PM

Wednesday:

8:00 AM-4:00 PM

Thursday:

8:00 AM-4:00 PM

Friday:

8:00 AM-12:00 PM

Saturday:

Closed

Sunday:

Closed

  • Copyright © 2023 MH Sub I, LLC dba Officite.
  • Admin Log In
  • Site Map