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Reducing Time in Patient Eligibility and PA: Wegovy and Zepound Case Study
Prior authorization (PA) is a process where healthcare providers must obtain advance approval from a patient’s insurance company before certain high-cost medications can be dispensed. For GLP-1 medications like Wegovy and ZepBound, this step ensures that the treatment is medically necessary and meets the specific criteria required by the health plan. This process also confirms that the patient is eligible for the medication under their insurance policy and protects against unexpected out-of-pocket expenses. Why Is Prior Authorization Important for Wegovy
Sophia Wilson
Automation Opportunities in Prior Authorization for Wegovy and Zepound
Prior authorization (PA) is the process where healthcare providers obtain advance approval from a patient’s insurance before certain medications are dispensed. For high-cost GLP-1 therapies like Wegovy and Zepbound, automation in prior authorization helps ensure the treatment meets medical necessity requirements, verifies patient eligibility, and prevents financial surprises streamlining access and reducing delays at the pharmacy. At Staffingly, we enable automation in prior authorization for Wegovy and Zepbound by managing the entire process end to end ensuring accuracy, speed, and
Sophia Wilson
Improving Efficiency in Eligibility and PA for Wegovy and Zepound
Eligibility and prior authorization for Wegovy and Zepbound is the process where healthcare providers obtain advance approval from a health plan before these high-cost medications are dispensed. This step confirms the patient’s coverage is active and that the treatment is medically necessary, aligning with the insurer’s specific criteria and guidelines. Why Is PA Important for Wegovy and Zepbound? Due to their price and growing demand, Wegovy and Zepbound face tight insurance restrictions. Prior authorization for these medications is essential for
Sophia Wilson
The Midnight Coverage Panic: Who Do You Call at 11:59 PM?
At 11:59 PM, the phone rang. Not a casual call the kind of ring that sends a jolt through your spine. One of our highest-needs clients, who required continuous overnight care, was suddenly left without a caregiver. The one scheduled had just been rushed to the ER with a family emergency of her own. There was no time to process. The shift started in one minute. Key Takeaways: Overnight Gaps Are High-Risk: There’s no such thing as “later” when a
Sophia Wilson
Handling Family Caregivers Who Need “Just a Few Days Off” Then Don’t Come Back
It always starts the same way: “I just need a few days off.” As agencies, we understand the pressure family caregivers face, and we’re happy to step in when they need a break. But what happens when those few days turn into weeks and then silence? Suddenly, what was meant to be temporary becomes permanent, and the gap in care grows wider by the day. Without a backup plan in place, both the patient and the agency are left scrambling.
Sophia Wilson
When You Add a Shift to the Calendar… But Forget to Assign It?
Quiet confession moment we’ve all done it. In the rush of managing schedules, caregiver updates, and client needs, it’s easy to feel a sense of accomplishment when you add a shift to the calendar. But if that shift isn’t actually assigned to a caregiver, it’s just a placeholder a silent oversight waiting to become a real-world problem. No one shows up. The client is left waiting. The family is frustrated. And suddenly, you’re dealing with a breakdown in care that
Sophia Wilson
“I Didn’t Realize It Was Live-In” The Confusion That Breaks Coverage
In home care, clarity is key especially when it comes to scheduling. A simple misunderstanding can lead to a no-show, leaving both the patient and agency in a bind. Take this situation, for example: a caregiver was assigned to a patient, but due to a miscommunication, they didn’t realize that the patient required live-in care rather than hourly visits. This confusion led to a critical gap in coverage and, ultimately, a frustrating experience for both the family and the agency.
Sophia Wilson
What Happens When You Mix Up Two Clients With the Same First Name?
In home care, accuracy is paramount, and a simple mix-up can quickly escalate into a larger issue. When clients share the same first name, it can be easy to assign the wrong caregiver to the wrong person, leading to missed appointments, frustrated clients, and potential disruptions in care. This seemingly small mistake can have a domino effect, impacting both the caregivers and the patients who rely on timely and proper care. In this article, we’ll explore the challenges that arise
Sophia Wilson
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