Prior Authorization for CRT Equipment Repairs: 7 Facts Every CRT User Should Know

At-A-Glance Summary

Many health insurance carriers require prior authorization to repair CRT equipment that’s already been approved. The process involves submitting several documents and other information to your insurance provider for approval. Waiting for approvals often adds one to four weeks to the process and can delay CRT users from getting the repair they need.

Key Takeaways:

• Many health insurance carriers require prior authorization to repair CRT equipment that’s already been approved
• The process involves submitting several documents and a variety of information to your insurance provider
• Waiting for approvals from your health insurance carrier often adds one to four weeks to the repair process
• Prior authorization creates bottlenecks in the process, delaying CRT users from getting the repair they need

What Is Prior Authorization?

Prior authorization is an insurance requirement that asks CRT providers to get approval before ordering repair parts, even when the equipment was previously approved as medically necessary.

Required Documents for Prior Authorization

Prior authorization for CRT repairs typically includes several documents, including:

• A prescription
• A repair evaluation
• An equipment or repair estimate
• A Letter of Medical Necessity (LNM)

Why Prior Authorization Delays CRT Repairs

Prior authorization creates bottlenecks in the repair process, mostly because multiple documents must be completed, submitted, reviewed and approved before any parts can be ordered. This delays CRT users from getting the repair they need to enjoy the levels of independence and mobility they desire.

A few ways prior authorization can slow down the process of making timely repairs include:

• The authorization process is lengthy, often requiring several types of documentation to be completed by different members of the CRT user’s care team, including physicians, therapists and Assistive Technology Professionals (ATPs). Waiting for approvals from your health insurance carrier often makes up for nearly half of the repair timeline, adding one to four weeks to the process.
• Authorization is required before ordering equipment or parts needed for a repair. It takes time to order, repair and deliver CRT equipment, and CRT providers cannot start the process until the health insurance carrier has approved.
• If prior authorization is denied, you must appeal the decision, which often means submitting or resubmitting additional documentation and waiting for the health insurance carrier’s decision.
• Even if your chair was previously approved and determined medically necessary, your health plan may require you to submit a prescription or Letter of Medical Necessity (LMN) for most repairs, even replacing a battery. Learn more.

Timeline & Solutions

Reducing or eliminating prior authorization for minor CRT repairs would significantly shorten repair timelines and help users avoid unnecessary health risks. Potential reforms include:

• Removing requirements for a prescription and a statement of medical necessity for repairs to equipment that has already been approved as medically necessary.
• Removing prior authorization or establishing a threshold up to $1,500 for minor repairs or frequently replaced parts to reduce unnecessary wait times and keep CRT users moving.

FAQs

What is prior authorization?

Prior authorization is basically asking your health insurance carrier for permission before ordering the parts to complete a repair on CRT equipment that has previously been approved as medically necessary.

How long does it take?

Prior authorization for CRT repairs often adds one to four weeks to the repair timeline, accounting for nearly half of the total repair process.

What documents are needed?

A prescription, a repair evaluation, an equipment or repair estimate and a Letter of Medical Necessity (LMN).

What if a request is denied?

If prior authorization is denied, the repair is delayed further while you and your care team submit additional documentation, and the insurance carrier reviews an appeal.

Did You Know You Can Make a Difference?

As a CRT user, your experience can help legislators and insurance carriers see the need for change. Legislation that seeks to remove or limit prior authorization is currently being considered in several states.

You can help by:

Educating Yourself

Prior authorization requirements can differ depending on the health insurance carrier. Learn about your insurance carrier’s requirements and who is responsible for each step in the process so you know who to reach out to if documentation is missing or delayed.

NOTE: If you change health insurance carriers at any time during the repair process, you will have to start the process over with your new insurance carrier.

Researching What’s Happening in Your State:

Follow advocacy organizations like NCART, iNRRTS, AAHomecare and other advocates to stay up to date about ongoing efforts and learn what is happening in your state. If legislation is under consideration in your state, research and seek to understand how it would change the prior authorization process for you and your health insurance carrier.

Sharing Your Story:

Reach out to your insurance carrier and elected officials at both the state and federal level and explain how changes to prior authorization would improve your daily life. Find your elected officials.

Making Your Voice Heard:

In many ways, private health insurance plans follow the example of Medicare and Medicaid. Call the Centers for Medicare and Medicaid Services (CMS) directly at 1-800-633-4227 to advocate for changes to prior authorization requirements.