Insurer keeps requesting more documentation for pre-auth - this is the fourth round and surgery is 3 weeks away
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 exhausted conservative treatment options - two years of physical therapy, three cortisone injections, prescription medications that stopped working. My surgeon's office submitted everything initially and got a letter back requesting additional documentation. They submitted that. Two more rounds of "additional information required" later, we are now six weeks in and I still don't have an approval. Surgery is scheduled for three weeks from now and I genuinely don't know if it's going to happen.
My employer's benefits coordinator says this is "normal" and to just keep submitting what they ask for. But each request is slightly different and the turnaround time keeps resetting. I'm starting to wonder if this is intentional delay. Has anyone been through this kind of repeated documentation cycle? Is there something I can do to force a decision rather than just endlessly responding to information requests?
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