37 Comments
How long does it typically take for your durable medical equipment or pharmacy supplier to obtain prior authorization or chart notes from your T1D health care provider’s office?
You must be logged in to post a comment.
© 2023 T1D Exchange. All Rights Reserved.
Varies considerably sometimes comes on time as supposed to and I dont have to call other times I call and it depends on the person answering knowledge I think. Especially variable on sensors as I dont think they know what they are talking about
I am not sure is the only answer I can give to automated systems. They ricochet like a pin ball machine from 1 day, to 4 months, to occasionally getting a notification a half year later. ¯\_( ͡⚈ ︵ ͡⚈)_/¯
It seems to vary. Sometimes, I have to contact my supplier, then my doctor’s office to get the ball rolling. There have been occasions where I’ve waited two to three weeks.
My doctor’s office tells me they have faxed the info as soon as they get the request but the medical supplier always seem to lose it. I make three or four calls each time to the doctor’s office and supplier each to get things rolling again. That is why I like to have a stock pile since I know how unreliable they are.
Same for me!
My experiences with DME suppliers have been abysmal. Switched from Edgepark to Byram several years ago but had the same issues – took FOREVER to get the correct paperwork to the correct people, and I had to personally call multiple times to follow up (which was never fun or efficient with all the automated menus that don’t even apply). It was the most frustrating part about diabetes!! I just switched to Advanced Diabetes Supply last month and the experience was phenomenal – I went straight to a live person when I called, and they had a person assigned to me that would check in periodically with updates. So far, it has been a fantastic change.
I changed from Byram to Edgepark several years ago because Byram NEVER got my order correct, or on time. I was constantly getting shorted, and/or incorrect substitutions from Byram. Edgepark at least gets the orders correct, although not always timely.
Had to check other as my experience puts comuication with Dr staff ranges from immediate to weeks. Occasionally I’ve been told docs faxed several times only for supplier to insist they’d not received paperwork. Once I hand carried chart notes from one location to another to insure it was done. Don’t know who is at fault but things get tense for me to see my supplies dwindle as I consider being forced back to multiple injections. Medicare rules only delay the prompt receipt making it a race between getting what’s needed before being out completely. I’ve been type one going on 54 years, what’s so hard to realize I will continue to require tools to treat it?
I answered 1-2 weeks but would add the delays seem to usually have been within the supplier’s bureaucracy, not those of the doctor’s office or the Medicare Advantage plan. and things seem to have been better recently. The exception is prosthetics and orthotics which can take up to 2 months.
I said other. Sometimes it takes 3-5 days, sometime 2 weeks and I have to call them and bug them…
Either way, I always feel it’s too long. It seems 2 business days should be reasonable.
My tandem pump supplies come from Byram. Re-supply always means there will be a major production getting approval to ship.
My Dexcom supplies are provided by US Medical. Always a smooth experience. For some reason US Med. is not an authorized supplier for Tandem products for Medicare patients. Go figure.
Only once with getting my DEX supplies, I was told by the operator they needed the Doctors chart notes. I just don’t understand why they needed his notes. (They, meaning the US FDA or other regulatory body), I guess they must think you can be cured with T1D, or you can change to pills (For me over 54 years.) or just stopping the medications??? Do you think Qualified Doctors really look at those notes? Most likely some clerk that just checks off a box.
It varies. The process seemed to be a little faster between our endo and Solara Medical Supplies for Dexcom and Omnipod Eros pods. Now we’re going through Caremark and still waiting to hear back from my endo about sending prior authorization to them. It’s been 3 days since I messaged my endo about it. I hope the turnaround is faster.
Until recently, I wasn’t even aware of the need for CCS Medical to get updated chart notes from my endo. I don’t remember this being needed or asked for after several years of getting my Dexcom supplies through them. It took over a month to get this all worked out. Luckily, I had a spare transmitter, otherwise I would have been sunk. Why hadn’t they given me a heads up? So frustrating.
I use the pharmacy associated with my Endo/medical hospital complex. I don’t have any delay in getting medicines and supplies.
Hard question to answer. My Doctor office responds to any requests in a day. My pharmacy also responds in a day.
The durable medical supplier, manufacturer, and insurance co. seem to take weeks
Thursday/Friday forget it! Mid week 3 to 5 days to fix whatever initial screw up they made. An ugly process…
I put 3-5 business days. Except for the time I waited 15 days to receive my insulin and test strips! It was a mix of problems due to a new P.A., pharmacy info, and on and on. Many hours spent on the phone for two weeks.
I hope some people at the supply companies read our comments. It seems pretty unanimous that we have problems getting medical supplies in a timely manner, and I wonder what can be done to fix this problem. It can’t be a vendetta aimed just at people in our situation, but something that needs to be fixed. Bureaucracy is a huge dragon waiting to be slain! Let’s get behind this!
It varies from month to month because of errors committed by the 3rd party DME supplier. Medicare may be my secondary insurance but is the primary roadblock to consistent quality.
I selected 3-5 days. CCS Medical has been a wonderful DME company to work with, they usually are on top of everything and if any questions or problems they either call or email me.
They just need authorization from my insurance. I haven’t had any troubles thankfully.
And I have to keeping reminding them to get on it. But it is what it is.
We have to realize that the delay is not always with insurance companies. I know many HCP’s so inundated with paperwork, it may take them 1-2 WEEKS just to fill out and submit a Prior Authorization.
Insurance companies are controlling the prescriptions more than providers unfortunately. AND when a Dr. Dream it medically necessary, insurance companies can AND WILL still deny, Deny, DENY!
Very sad and upsetting.
I feel this is burdensome keep-busy work placed upon the health provider office. The office I deal with is very conscientious and prompt. I wish they were being called upon to provide health services rather than redundant paperwork.
It depends on many times the DME loses them once the faxed. It also depends on the DME company. Tandem had all the paperwork from my endocrinologist within 24 hours. Then the DMR company, that was supposedly in network, called and said they were no longer in network and could not supply my new pump. When I called the insurance about it & who I was supposed to use, they were surprised since they had not dropped them.
They were also charging a copay for pump supplies and Dexcom supplies, which didn’t have one.
My health care provider is not the bottleneck. It’s insurance or the DME provider.
I have medicare. It takes a lot of time for the pharmacy to realize that real Time glucometers are covered as DME. Sometimes months.
I have been working since April 2022 to get my Blue Cross/Blue Shield Federal Employee Program to cover Insulet’s Omnipod 5 system. Since Insulet partnered with a company called ASPN to coordinate Health Insurance coverage, things are getting done. My Omnipod 5 is expected to arrive next week; “what a long hard road its been”. Now lets see how long I will have to wait to get an appointment with my CDE so that I can be trained on how to use the new system.
I have also been trying to get Insulet’s Omnipod 5 system since April. I was told 3 weeks ago from ASPN that everything was approved and it was forwarded to Pill Pak (Amazon) for shipping. Nothing- I spent several hours on hold with both ASPN and Pill Pak -ASPN said they sent the prescription 3 weeks ago and Pill Pak said they do not have it. My doctor also sent it directly to Pill Pak last week after they asked me to have him send it directly to them and ASPN also says they sent it again. PIll Pak still denies having it. This is such a ridiculous run around – I’ve never had this much trouble getting any supplies-very frustrating!!
Issues have always been the suppliers…..not my Dr office when there is an issue. Lately it’s because of Medicare transition.
The approval time has varied from already having it when I placed my refill to having my supplier (Byrum)delay my delivery because of communication issues . I have had to contact my endocrinologist and have the team straighten out the red tape. I’m on Medicare so you can’t reorder until you’re down to less then 10 days. That is an unreasonable assumption considering all the paper trail mazes.
Like Sue Martin, I have zero complaints for the same reason. My doctors, specialists, labs, pharmacists are all in one organization. If a doctor writes a prescription, I can pick it up the same day within an hour. If I request a refill I have the choice of picking it up or having it mailed in 2 to 3 days. No problems with Dexcom or Byram. I’m on the cheapest Medicare Advantage plan at Kaiser Permanente. I guess my doctors, pharmacists, nurses, dietitians, support techs are computer savvy and know how to cut red tape. We have a very aggressive state health commissioner and a very aggressive state attorney general who look out for little guys like me. That’s why I put up yard signs and send politicians emails and phone calls at city, county, state and national levels. I’ve personally lobbied at all levels of government with organized progressive left wing groups. I’ve contributed $5 here , $25 there. Over decades I’ve donated to Public Citizen, People for the American Way, League of Women Voters, public broadcast radio and TV stations, Green Peace, 350.org, anti war groups, Dr. Faustman at Harvard, Juvenile Diabetes Research Foundation, etc. I can’t donate much, but I give what I can. It’s not enough to complain, you’ve got to join an organization and sometimes get out and demonstrate on the sidewalk or in the street. First time is scary. But you make friends with wonderful people.
Did I forget to mention Physicians for a National Healthcare System? Common Cause? Southern Poverty Law Center? Drug Policy Alliance? Credit Unions? Food Co-ops and Farmers Markets? Whole Washington? Union of Concerned Scientists?
I just made my first order on Medicare, and it was delivered about 2 days later, after they listed all those things they’d have to confirm!
I chose 3-5 business days. Sometimes it is less than that and sometimes more. The delay is often the supplier says “We sent a fax last week with no response (well why didn’t they retry?) or the medical office says they never received a fax request (which I’ve confirmed was sent”. Once I call both places DURING business hours and have them refax the request, then it seems to work. I don’t try to fix whatever the technical or staffing problem is causing the problem. That would take more time than just calling my doctor’s office ahead of time and saying to watch for the incoming fax. LOL!
It doesn’t seem to take more than a week or two, but I really don’t know for sure.