“Prior Authorizations, Mrs. Kafka. May I have your name and the patient’s policy number.”
“My name is Hans Duvefelt, and I don’t have the patient’s number but I have her husband’s – it is 123456789”.
“Thank you, Doctor. This is for Harry Black?”
“Well, no, it’s for his wife, Harriet. We asked for a PA for Lyrica for her, but it was approved for him instead, even though the forms we sent you clearly stated her name.”
“I see that Harry is approved for one year.”
“Yes, but he doesn’t need it. He has no diagnosis and no symptoms. Someone at your end reversed the names, because the application was for Harriet. I have a copy right here in front of me. So can we just get this approval switched over to her name instead?”
“I’m sorry, we can’t.”
“But why?”
“She’s a different patient.”
“But everything we sent in was on her. You were the ones who put it under his name instead. It was your mistake and I’m asking that you correct your mistake.”
“I’m sorry, but we have to process Harriet’s Prior Authorization separately. What is her diagnosis?”
(Sigh)
“Postherpetic neuralgia.”
“Is she currently taking Lyrica for this?”
“Yes.”
“I don’t see any pharmacy claims for Lyrica in her profile.”
