Prior Authorization
Also known as: PA, Pre-auth, Pre-certification
Insurer approval required before certain expensive supplies or medications are covered.
Prior authorization is a process where a health plan requires approval before it will cover certain services, medications, or equipment. For diabetic supplies, prior authorization is commonly required for CGM systems, insulin pumps, and sometimes therapeutic shoes.
The prior auth process typically involves: your prescribing physician submitting clinical documentation (diagnosis codes, lab results, medication list, attestation of need), the insurer reviewing within a set timeframe (usually 1–5 business days for non-urgent requests), and a coverage decision.
For Original Medicare, CGMs and insulin pumps require documentation but technically go through a coverage determination by the DME supplier/Medicare, not a separate PA process. For Medicare Advantage, PA is standard for these high-cost items.
A DME supplier handling PA on your behalf will contact your doctor for necessary documentation. Denials can be appealed — and are frequently overturned when complete clinical records are submitted.
Frequently asked
What is Prior Authorization?
Insurer approval required before certain expensive supplies or medications are covered. Prior authorization is a process where a health plan requires approval before it will cover certain services, medications, or equipment. For diabetic supplies, prior authorization is commonly required for CGM systems, insulin pumps, and sometimes therapeutic shoes.
How does Prior Authorization relate to Medicare coverage?
Medicare Part B covers most durable medical equipment related to Prior Authorization. Contact us to verify your specific coverage for related diabetic supplies.
Where can I get diabetic supplies related to Prior Authorization in Phoenix?
We deliver Medicare-covered diabetic supplies throughout the Phoenix metro area. Call us or complete the form above to verify your coverage.