Prior auth requirements and denials
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...