Pre-AuthorizationPosted by patient_renter_128

Doctor's office says they submitted prior auth - insurance says they never got it

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 confirm and they said they have no record of any prior auth request from my doctor's office. My doctor's office insists they sent it and have a fax confirmation. Neither side will budge and my procedure is in 8 days.

I've now called my insurance four times this week. Each rep tells me something different - one said the request went to the wrong department, another said it was submitted under the wrong code, and a third said it simply doesnt exist in their system. My doctor's office is frustrated too and says this happens "all the time" which honestly makes me feel worse, not better.

I cant postpone the procedure - it's time-sensitive and I've already scheduled time off work and arranged childcare. Has anyone dealt with this specific situation? Is there a way to escalate this quickly? Do I just show up and hope it works out, or is there actual recourse here?

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Doctor's office says they submitted prior auth - insurance says they never got it | ClaimCave