Hi. I have a shoulder problem that I’ve been to ortho for. They looked at my insurance (Aetna Managed Choice open access is Primary, Healthlink State of IL employees is secondary) and said “we will submit the prior authorization request, and you might as well go ahead and start physical therapy now because they will deny it.” Ok, no problem. And they did. So after a month of PT, therapist says she is going to send a progress note to my dr recommending that we stop PT because it’s not helping at all, and the pain in just getting worse. She said sometimes they will look at that and go ahead and authorize it but I may have to return for the other 2 weeks of therapy.
I have heard that if you submit a FOIA request and ask to see the name and credentials of every person who accessed your information to make the determination to deny the PA, usually they will go ahead and approve it because most of the time the people making the decisions have no medical credentials whatsoever. Any truth to this? Or any advice on how to speed up this process?
We are thinking it’s a labrum tear and bicep tendon tear or impingement. PT says probably a micro tear that has been made worse over the last few months. I literally can’t fold laundry. Dr doesn’t want to give me any more shots (I’ve had 4 over the last 7-8 years) until we get the MRI to see if there is something going on that may be worsened if I the pain goes away and I overdo it.
submitted by /u/Unwilling-Accountant
[link] [comments]Hi. I have a shoulder problem that I’ve been to ortho for. They looked at my insurance (Aetna Managed Choice open access is Primary, Healthlink State of IL employees is secondary) and said “we will submit the prior authorization request, and you might as well go ahead and start physical therapy now because they will deny it.” Ok, no problem. And they did. So after a month of PT, therapist says she is going to send a progress note to my dr recommending that we stop PT because it’s not helping at all, and the pain in just getting worse. She said sometimes they will look at that and go ahead and authorize it but I may have to return for the other 2 weeks of therapy. I have heard that if you submit a FOIA request and ask to see the name and credentials of every person who accessed your information to make the determination to deny the PA, usually they will go ahead and approve it because most of the time the people making the decisions have no medical credentials whatsoever. Any truth to this? Or any advice on how to speed up this process? We are thinking it’s a labrum tear and bicep tendon tear or impingement. PT says probably a micro tear that has been made worse over the last few months. I literally can’t fold laundry. Dr doesn’t want to give me any more shots (I’ve had 4 over the last 7-8 years) until we get the MRI to see if there is something going on that may be worsened if I the pain goes away and I overdo it. submitted by /u/Unwilling-Accountant [link] [comments]Read Morer/HealthInsurance