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How to get a Hydromorphone prior authorization approved under 5 business days?

Prior authorizations can feel like quicksand. Pharmacies say they’re waiting, doctors say they already faxed, insurance companies say they never got anything. In the middle of all this, patients are left without their medication. That’s where our outsourcing team comes in.

This case was for Hydromorphone, which is heavily monitored and requires extra documentation. The patient couldn’t afford weeks of back and forth. Here’s how it unfolded.

Day 1 – Tuesday: First Call

The patient reached out because the pharmacy said they still didn’t have the approval. Our CEO took the call, confirmed all the details, and moved the case straight into priority handling. No waiting for it to trickle through the system.

Day 2 – Wednesday: Fax Troubles

Insurance claimed they hadn’t received the paperwork. We didn’t take that at face value. Our staff called, verified the correct Sunshine Health fax number, and re-faxed the prior authorization package with everything on letterhead. Then we stayed on the line to confirm it was being entered into their system.

Day 3 – Thursday: Insurance Delay

This time, the insurance company admitted they had the documents but asked us to allow 72 hours for review. We updated the patient right away and advised them to also call from their side. Dual pressure always works better than silence.

Day 4 – Friday: Escalation Mode

The payer confirmed they had received the required urine drug screen reports and supporting documents. Still, they asked for another 48 hours. We kept this case on top of our queue, followed up consistently, and made sure nothing got lost in the shuffle.

Day 5 – Monday: Approval Secured

The prior authorization was officially approved. Hydromorphone was cleared, the pharmacy was notified, and the patient had their medication. A process that often drags out for weeks was closed in 5 business days.

Why this worked?

• We verified everything directly with the payer.
• We resent documents immediately when needed.
• We stayed on hold with insurance so nothing got lost.
• We kept the patient fully updated.
• We escalated the case until the approval came through.

Pre-authorization and prior authorization delays don’t have to control the timeline. With outsourcing, a focused team can drive approvals faster and reduce the stress for both patients and providers.

Actual Conversations From the Case

Patient to Staffingly:

“Okay, I called my insurance company to see if they got the fax, and they said they have not received it yet. I want to make sure you have the right fax number. Can you check?”

Staffingly team response:

“The team is currently on call with the insurance company and has already re-faxed the documents. The rep requested we allow at least 3 hours for the fax to be received. Once they confirm, the turnaround time for a decision is 72 hours. We also called you to update you directly.”

Follow-up:

“Insurance confirmed they received the recent UDS reports but need 48 hours to update this case. We’ve updated the patient and advised him to also reach out from his side to expedite the decision.”

Final update:

“Medication got approved. Patient contacted and informed.”

Takeaway

Hydromorphone cases are never simple. But when you put pre-authorization and prior authorization in the hands of a dedicated outsourcing team, the process moves. Staffingly, Inc. makes sure cases don’t just sit in a fax pile. We push them through.

What People Are Asking?

Why does it feel like my medication is stuck in quicksand?
Prior authorizations involve multiple parties pharmacies, doctors, and insurers so delays are common without active follow-up.

Can a prescription like Hydromorphone really be approved in just 5 days?
Yes! With a focused team verifying documents, re-faxing, and staying on hold, approvals can happen much faster than usual.

What happens if insurance claims they never got the paperwork?
A proactive team double-checks fax numbers, resends documents, and confirms entry into the insurer’s system to prevent lost files.

Do patients need to chase their insurance companies themselves?
Not always. But dual pressure team follow-ups plus patient calls often speeds up approvals.

Why outsource prior authorizations instead of handling it in-house?
Outsourcing ensures a dedicated team tracks every step, escalates issues, and keeps patients informed, reducing stress and delays.

Disclaimer

For informational purposes only; not applicable to specific situations.

For tailored support and professional services

Please contact Staffingly, Inc. at (800) 489 5877

Email: support@staffingly.com

About This Blog: This Blog is brought to you by Staffingly, Inc., a trusted name in healthcare outsourcing. The team of skilled healthcare specialists and content creators is dedicated to improving the quality and efficiency of healthcare services. The team passionate about sharing knowledge through insightful articles, blogs, and other educational resources.