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Dr. Wasim Haque
V. Jane Zepeda, PA-C
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Prior Authorization Forms
Formularies and prior authorization requirements are, in our opinion, barriers to your care. These rules were created for the sole purpose of increasing profits to insurance companies; they have absolutely nothing to do with good medical care. Your physicians & you the patient are the ones who are inconvenienced.

Our office will do it’s best to try and obtain a prior authorization for your prescription drugs as per your request. In order to do this, you will need to obtain your insurance carrier's prior authorization form and bring them into our office. These forms will be filled out based on your medical record as well as any additional history you give us during this appointment. If the prior authorization form has to be filled in your absence, we will charge $25. This fee is not covered by your insurance company.

We cannot guarantee that a health plan will approve any prior authorization request. These decisions are strictly made by the insurance companies based on their individual criteria. Any complaints or concerns that you may have regarding prior authorization should be addressed with your benefits department.