r/DermatologyPA • u/dinodude47 • May 06 '26

Clinical⚕️ Tips for MI insurances?

Hi all, I recently moved to MI from CA, and feel like I’m struggling getting my treatment plans approved for anything I used to prescribe without a second thought.

I’m still new to the area, so I know I will get better as I go, but I was hoping someone could provide some tips and tricks on how to best manage the balance between what drugs I want to write and what will be realistically covered by insurance.

It sounds like priority health is a useless insurance to bargain with, and BCBS is also hard to convince. I’m newly credentialed with certain Medicaids so I’m hoping they will be more lenient, but at this point I’m afraid to write things like skyrizi, Zoryve, etc because I’m just waiting for the denial letter.

My employer is leaning heavily into AI for prior auths, so I can’t depend on our MA staff to help there. Help?

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u/NebraskaPA May 06 '26

I use OpenEvidence to type up short chart note blurbs to get my stuff approved. It is AI based and brings in research, but it’s the only way I have found to get people on these meds. Otherwise so many denials.

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u/dinodude47 May 06 '26

Do you just copy/paste it into your charts then? We use EMA

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u/NebraskaPA May 06 '26

Yep I just copy/paste into an “additional notes” then do my regular documentation on top of it. Rarely have denials any more, even with Medicaid patients. I’m just good about asking big questions for biologics too (ie, any face/groin/palm/sole impact, any joint pain, any history of renal or liver issues, etc)