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Form F-11092 Prior Authorization / Preferred Drug List (Pa / Pdl) for Growth Hormone Drugs - Wisconsin
What Is Form F-11092?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-11092?A: Form F-11092 is the Prior Authorization/Preferred Drug List (Pa/Pdl) for Growth Hormone Drugs in Wisconsin.
Q: What is the purpose of Form F-11092?A: The purpose of Form F-11092 is to request prior authorization for growth hormone drugs or to determine if a specific drug is on the preferred drug list.
Q: What is prior authorization?A: Prior authorization is a process where a healthcare provider must get approval from an insurance company before prescribing a certain medication.
Q: What are growth hormone drugs?A: Growth hormone drugs are medications that are used to treat growth disorders in children and adults.
Q: What is the Preferred Drug List (PDL)?A: The Preferred Drug List (PDL) is a list of medications that have been selected by an insurance company as preferred choices for certain conditions.
Q: Who needs to use Form F-11092?A: Form F-11092 needs to be used by healthcare providers who want to prescribe growth hormone drugs and by patients who want to check if a particular drug is covered by their insurance.
Q: What information is required on Form F-11092?A: Form F-11092 requires information such as patient's name, date of birth, insurance information, diagnosis, and details about the prescribed medication.
Q: What happens after submitting Form F-11092?A: After submitting Form F-11092, the insurance company will review the information and provide a decision on whether the medication is approved or if an alternative drug is recommended.
Q: Can I appeal if my request is denied?A: Yes, if your request for growth hormone drugs is denied, you have the right to appeal the decision and request a review of the denial by the insurance company.
Form Details:
- Released on July 1, 2020;
- The latest edition provided by the Wisconsin Department of Health Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form F-11092 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-11092 Prior Authorization / Preferred Drug List (Pa / Pdl) for Growth Hormone Drugs - Wisconsin
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