The Prior Auth Nurse

06/16/2026

Quick tip from a pediatric nurse with 25 years on the inside.

Bring a notebook to every single appointment. Write down the date, the provider’s name, what was said, what was ordered, what the next step is, and who is responsible for that next step.

Not because you don’t trust your child’s care team. Because the system doesn’t talk to itself. Your child’s pediatrician doesn’t always know what the specialist said. The specialist doesn’t always know what insurance denied last month. The school doesn’t know what the doctor recommended.

You are the one constant in your child’s care. Your notebook is the thread that holds it all together.

It sounds simple. It has changed outcomes for families I’ve worked with for years.

Start at the next appointment. 📓

06/12/2026

Most denials that get appealed get overturned. Most never get appealed. Don’t let yours be one of them — free tools to start your appeal, link in bio. 🫶

06/12/2026

An ABA waitlist can run six months to a year. But "waiting" and "doing nothing" are not the same thing.
If you just got the referral and the first thing they said was "we'll call you when a spot opens" — read this. There's real work you can do right now that makes the wait shorter and the start smoother.

I'm Jen — a pediatric LPN with 25+ years getting kids' care approved. The families who start strong are almost always the ones who used the wait instead of just enduring it.

Five moves while you wait:
1️⃣ Get on more than one waitlist. You can hold multiple spots at once and take the first slot that opens. Waiting on a single "perfect" provider can cost you months.
2️⃣ Get the paperwork done NOW. The diagnostic evaluation, the prescription/order for ABA, and the insurance prior authorization — having all three ready means you can start the day a slot opens instead of beginning the approval process then.
3️⃣ Ask to be on the cancellation list. Slots open on short notice. Families who say "call me for anything, even one day's notice" get seen sooner.
4️⃣ Don't let the wait be empty. Ask your child's team about other covered services you can use in the meantime — your child doesn't have to be getting nothing while the ABA clock ticks.
5️⃣ Keep everything in writing. A waitlist is not a coverage denial — and dated records of referrals, requests, and responses become your evidence if you ever have to push.

The part that gets case-by-case: when the insurance side fights you — ABA denied as "not medically necessary," or approved hours cut below what was recommended — that's a specific appeal with specific medical-necessity language. The framework is the same; the wording is the weapon.

Start free 👉 the Parent Survival Map walks the whole services-and-systems stage, and if a denial shows up, the Denial Decoder reads it for you in plain English. Both free at thepriorauthnurse.com (link in bio).

👇 How long is your ABA waitlist right now? Drop your number below — it helps other parents know they're not alone.

📌 Save this if you're waiting (or about to be).
💙

06/11/2026

You don’t have to figure this out alone. Free tools to decode your denial, draft your appeal, and track your deadlines — link in bio. 🫶

06/10/2026

"Step therapy" is the policy that lets a plan make your child fail on a cheaper medication before it'll cover the one their doctor actually prescribed.
Yes — even if your child was already stable on that medication for years. A new plan year can treat them like a brand-new patient and demand they "try the cheaper options first." Parents call it "fail first," and it feels exactly as wrong as it sounds.
Here's the part nobody tells you: it's a policy, not a wall. And policies have override processes built right into them.

I'm Jen — a pediatric LPN with 25+ years getting kids' care approved. "Fail first" is one of the most beatable denials out there once you know it has a name and an override.

What to do, in order:
1️⃣ Read the denial letter for the words "step therapy" or "step protocol." That's your signal this is what you're dealing with — and that a specific override exists for it.
2️⃣ Ask the prescriber's office to request a step-therapy exception (sometimes called a "protocol override"). Most plans are legally required to have a process for this — you just have to invoke it by name.
3️⃣ Document the history that qualifies you for the override — already tried the cheaper drug? Already stable on the current one? A change risks harm? Those are the exact grounds exceptions are granted on.
4️⃣ Mind the deadline. Every appeal has a clock, and it's usually shorter than you'd guess. Missing it means starting over.

The part that's case-by-case: the override request has to cite your plan's specific exception criteria and your child's documented history — generic "please reconsider" letters get denied. That's where the condition-specific language does the heavy lifting.

Start free 👉 paste your denial into the Denial Decoder and it'll tell you in plain English whether you're looking at step therapy and what your deadline is. It's free at thepriorauthnurse.com (link in bio), along with the Appeal Letter Starter and Deadline Tracker.

👇 Has a plan ever made your child "fail first" on a medication? What were they forced to try? Tell me below.
📌 Save this for the day a refill comes back denied.

06/09/2026

🏡 Before the appeals, the binders, the phone calls — there's you.
We just opened a private community for parents navigating diagnosis, denials, waitlists, and the exhaustion nobody warns you about. Every week, Jen — a pediatric nurse of 25+ years — takes a new topic and walks through it with the group, one piece at a time.

This week: The Foundation — the regulated parent underneath every fight. The system is built to outlast you; you can't out-stubborn exhaustion. So we start here.
Come find people who get it 👉 https://www.facebook.com/share/g/1SR1Jgo8bu/
— Jen Morris, LPN

06/08/2026

Most insurance denials that get appealed are overturned. The catch? Barely 1 in 10 ever get appealed.

So if a pharmacy or plan has ever told you your child's medication is "denied," "not covered," or "needs prior authorization" — read this before you panic, switch meds, or pay out of pocket.

I'm Jen — a pediatric LPN with 25+ years spent getting kids' care approved. I built The Prior Auth Nurse so you don't have to learn this the hard way like the families I've watched do for two decades.

A denial is not a verdict. It's the start of a process the system is quietly betting you won't finish.

Here's what's usually really going on — and the first moves that work, no matter which medication it is:
1️⃣ Find out which kind of "no" it is. Formulary exclusion? Step therapy? Quantity limit? Prior auth needed? A non-medical switch? Your denial letter names it — and each one has a different counter. (Not sure what yours says? Our free Denial Decoder reads it back to you in plain English.)
2️⃣ Ask the prescriber's office for the right request. If your child was already stable on the medication, the phrase that matters is "continuation of therapy" — not a brand-new prior auth. That one distinction quietly wins a lot of cases.
3️⃣ Get the history in writing. A Letter of Medical Necessity that documents the diagnosis, what's already been tried, and why this medication — that's the document appeals live or die on.
4️⃣ Watch the clock. Every plan has an appeal deadline, and it's usually shorter than you'd think. Miss it and you start over from zero.
The part most parents miss: you have to rebut the specific reason printed on the letter. A generic "I disagree" goes straight in the trash — and that's where it gets case-by-case.

Start free 👉 the Denial Decoder, Appeal Letter Starter, and Deadline Tracker are all free at thepriorauthnurse.com (link in bio). Paste in your denial and we'll point you the right way.

👇 What word did your denial letter use — "step therapy"? "not medically necessary"? "non-formulary"? Drop it in the comments and I'll tell you what it actually means.

📌 Save this for the day you need it.

Plain-English insurance appeals, SSI applications, and Medicaid navigation for parents of children with chronic conditions, special needs, and disabilities. From Jen Morris, LPN.

06/05/2026

Hi everyone — I’m Jen. 🥰

Mom of 4, Gigi to a sweet 4-year-old little man who’s level 3 and nonverbal, and a pediatric nurse for the last 25 years (19 of them at one practice I watched grow from 3 providers to 11). I gave a lot of those kids their 2-month shots and then their college shots ….and my heart still smiles every time I think about watching them grow up!

Somewhere along the way, healthcare lost that sense of family. The feeling that someone will pick up the phone when you need help and ride the whole thing out with you. That’s what I’m trying to rebuild.

Here’s the thing I learned from the clinic side: I know the rules. I know what insurance actually wants to see, and I know how denials work…and now I’m living it from the parent side too, in real time, with my own family. It is HARD. There’s no guidebook for this. So I’m building one.

It really comes down to a series of phases you move through and most families get stuck simply because no one ever told them what the next step was. That’s the gap I want to close.

I’ve put together some free resources to help including a tool that translates a denial letter into plain English so you actually understand what insurance is saying and why. There’s also guidance on the phases you’ll go through, and even some on regulating yourself through the stress, because that part is real too.

You’re not alone in this. We all just want to know the next step so let’s figure it out together. 🫶 (Link in Bio)

06/02/2026

Lots of parents I talk to in these groups either have never heard of SSI for their child or don't know how to even begin to navigate the system to apply for it.

The ones who have were usually told "you make too much money" on the first phone call — without anyone running the math.

That answer is often wrong.

For a child's SSI application, SSA does not look at gross household income. They use a process called deeming, which applies a series of deductions before deciding what actually counts. Most parents who get told no never hear that calculation out loud — and they have the right to.

I just published a free 22-page guide for parents in exactly this position. It walks through what SSI actually is, who really qualifies, the deeming math you were never told about, what's at stake financially (cash + Medicaid + retroactive benefits), and the exact phone call to make to start the application — with the words that protect your filing date for retroactive benefits.
Free. Plain language. No catch.

Link to the guide in comments and on our homepage.

— Jen Morris, LPN
Pediatric nurse for 25+yrs, turning insider knowledge into parent empowerment.

06/01/2026

You were handed the most complicated system in the world on the worst day of your life and told to figure it out alone.
No wonder you're exhausted.
No wonder you can't stop.
No wonder your body is screaming.
That was never supposed to be your job alone — and from here on out, it doesn't have to be.
⸻
I'm Jen. I'm a Virginia-licensed pediatric Licensed Practical Nurse with over 25 years of experience getting children's care approved.

I built The Prior Auth Nurse because I watched too many parents carrying all of this alone — the diagnosis fight, the waitlist fight, the insurance fight, the IEP fight, and underneath all of it, the body and the grief and the exhaustion that nobody named for them.

Whatever phase you're in right now — whether you're still trying to get your child evaluated, or you just got the diagnosis and don't know what comes next, or you're staring at a denial letter, or you're past all of that and still tired — there's something here for you.

🆓 Three free tools to start with
📄 Plain-English appeal packs ($17 each)
📞 1:1 help when templates aren't enough

No clinical advice. No legal advice. Just someone who's been in the room — explaining the system to the parent who's tired of decoding it alone.

👉 Start at thepriorauthnurse.com (link in bio)
You're not failing. The system was designed to make you give up. That's the part nobody told you.