Prior auth requirements and denials
looking for advice from anyone who has been through a pediatric pre-auth denial. my son is 9, has been snoring loud enough to hear from down the hall for almost 2 years, sleeps with his mouth open,...
So ive been trying to get an MRI authorized for about 6 weeks now and im losing my mind. Started having episodes of right-side weakness and visual disturbances in mid April. My PCP referred me to a...
Had an outpatient knee procedure done in February. Before scheduling, my surgeons office called my insurance, got a pre-authorization number, and the rep on the phone confirmed coverage. I have the...
Posting this because pre-authorization denials on diagnostic imaging are one of the most common and most successfully appealed health insurance disputes, and the framework for reversal is much more...
My husband is 52, an HVAC technician in Fort Worth, with documented L4-L5 and L5-S1 disc herniations confirmed on two separate MRIs eight months apart. The second MRI shows progression with new...
My wife is 41, had a labral tear on her left hip diagnosed by MRI back in November 2024. Since then she has done 14 months of physical therapy (3 separate scripts, 36 total sessions), two...
Quick background. Two herniated lumbar discs (L4-L5 and L5-S1), radiculopathy down my right leg, foot drop intermittent for the last 5 months. MRI is unambiguous, EMG confirmed the nerve involvement,...
My surgeon submitted a prior authorization request for a spinal fusion surgery six weeks ago. My pain management doctor, my orthopedic surgeon, and my physical therapist have all documented that I've...
I need help understanding if what my insurance company did is actually allowed. Back in December my doctor's office obtained prior authorization for a surgical procedure. We got the approval in...
I was diagnosed with moderate sleep apnea after a sleep study my doctor ordered. My sleep specialist prescribed a CPAP. Seems straightforward, right? I've now had three prior authorization requests...
My orthopedic surgeon has recommended a rotator cuff repair surgery for me. I've had two cortisone shots, done six weeks of physical therapy, and the MRI shows a complete tear. My surgeon submitted...
I feel like i am losing my mind. I have a procedure scheduled for next week that my doctor said requires prior authorization. They submitted it three weeks ago. I called my insurance last week to...
Six months ago my neurosurgeon recommended a lumbar fusion. Not exactly news I wanted to hear but after two years of conservative treatment going nowhere, surgery was the next step. What followed was...
My orthopedic surgeon recommended knee surgery. Submitted prior auth and insurance denied it saying I need to try 6 more weeks of physical therapy first. Ive ALREADY done 12 weeks of PT with no...
Insurance changed their formulary and now a medication Ive been taking for 5 years requires prior auth. Doctor submitted it, denied. Appealed, denied again. Now I have to try two other medications...
Wanted to share my experience with a pre-authorization claim since I learned a lot from this community when I started.Filed in October, adjuster came out within a week. Initial offer was about 40% of...
Got the denial letter today for my pre-authorization claim. They're saying its not covered but I dont understand why.Has anyone successfully appealed something like this? Do I need a lawyer or can I...