Our prior authorization appeal letters are widely used. But do they work? The College’s prior authorization (PA) toolkit has become one of the most popular sections of our website. What’s the big draw? Our prior authorization appeal letter generator enables allergists and their staff to create customized, scientifically-based prior authorization appeal letters for their patients. The following drug/disease combinations are currently available, with more to come:
- Cinqair/Asthma
- Dupixent/Asthma
- Dupixent/Atopic Dermatitis
- Fasenra/Asthma
- Nucala/Asthma
- Odactra/Allergic Rhinitis
- Xolair/Asthma
- Xolair/Urticaria
But the big question is, do the letters work? To get answers, we reached out to our members. All in all, the feedback was very positive.
Jeremy Katcher, MD, FACAAI, used the Xolair/Urticaria appeal letter and was successful in getting Xolair approved. “Though it was still frustrating to have to complete a PA appeal and to dig through the patient’s medical record to find all the pertinent information, the template letter generator was very helpful in putting it all together. It saved a lot of time to just insert the data, and not have to worry about writing a letter. In addition, since this letter template is created by allergists, for allergists, I know the information and format provided are the most appropriate,” said Dr. Katcher.
Razi Rafeeq, MD, FACAAI, had success with the letters as well. “We have used the Dupixent, Nucala and Xolair PA appeal letters, and they all worked well. We got the biologics approved. Our staff is very comfortable with the process now and we plan to use them regularly,” he said.
Haejin Kim, MD, used the Xolair/Asthma appeal letter recently with great success. “Blue Cross Blue Shield recently denied Xolair for one of my patients who had two asthma exacerbations in the last calendar year. BCBS had required the patient to be on chronic daily steroids. I was able to use the letter generator citing her concurrent diabetes as a reason for not wanting to use daily steroids, and we had a response in 48 hours approving the medication,” said Dr. Kim. “It’s a wonderful tool, and I hope other allergists realize how helpful it is.”
“The PA appeal letters are easy to use,” said Allen Meadows, MD, FACAAI, president-elect of the College. “My staff enters clinical data about the patient and then sends the generated Word document to me. I can add other information unique to the patient, and my staff sends it to the insurance company for approval. The prior authorization letter generator has helped us get medications approved,” said Dr. Meadows.
Creating an appeal letter is easy. Just follow the online prompts and enter information about the patient and the insurance company. Information about you and your practice is automatically included. A draft customized appeal letter is created, which you can easily edit.
The prior authorization toolkit has other valuable resources as well. You can find tips and tricks from allergy PA experts to help make your process more efficient. We’ve also got terrific educational resources you can download for your patients. And finally, if you’ve always wondered how insurance companies make PA decisions and what exactly they’re looking for, we’ve got you covered. We have a short video featuring an allergist who is now a medical director for a large insurance company, and he provides an inside perspective on how those decisions are made.
When researching the effectiveness of the PA appeal letters, we found many College members are still not aware of how they can help their practice. If that’s you, don’t delay – check out our PA toolkit and letters today! Your staff members can also access them using your login credentials.
