I have Healthfirst Medicaid Managed Care in NY. I have a script from the doctor for physical therapy for my shoulders. In my handbook, it says you need prior authorization for PT. They have to review your case and then they let you know how many sessions you can do. Insurance rep on the phone said to fax the script. We did, we check up the next day and they say they never received it and the doctor is the one who is supposed to send it.
We call the doctor and the woman who handles it didn’t understand what I was talking about. She said, she faxed it over to the physical therapy place and you just go get physical therapy right away.
We call Healthfirst again and they say the physical therapist office is supposed to send the script to something called OrthoNet and they review it for authorization.
We call the physical therapy place and they say they never received anything. They mentioned something about an evaluation, but how can I have an evaluation without prior authorization? None of this makes sense and no one seems to know anything.
My parents assume that the physical therapy place wouldn’t schedule an appointment without authorization from the insurance company but is that true? I just assume they would bill Healthfirst and if Healthfirst didn’t authorize it, they would refuse to pay.
Can anyone help?
submitted by /u/rattlesnake30
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I have Healthfirst Medicaid Managed Care in NY. I have a script from the doctor for physical therapy for my shoulders. In my handbook, it says you need prior authorization for PT. They have to review your case and then they let you know how many sessions you can do. Insurance rep on the phone said to fax the script. We did, we check up the next day and they say they never received it and the doctor is the one who is supposed to send it. We call the doctor and the woman who handles it didn’t understand what I was talking about. She said, she faxed it over to the physical therapy place and you just go get physical therapy right away. We call Healthfirst again and they say the physical therapist office is supposed to send the script to something called OrthoNet and they review it for authorization. We call the physical therapy place and they say they never received anything. They mentioned something about an evaluation, but how can I have an evaluation without prior authorization? None of this makes sense and no one seems to know anything. My parents assume that the physical therapy place wouldn’t schedule an appointment without authorization from the insurance company but is that true? I just assume they would bill Healthfirst and if Healthfirst didn’t authorize it, they would refuse to pay. Can anyone help?
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