I had a procedure done (vasectomy) which is excluded under my insurance plan. I decided to try to get it covered anyway as my wife and I carry a genetic defect that affects both of our children. My insurance suggested I attempt to get a prior authorization, and if that was denied to appeal the decision.
We received a prior authorization, specifically stating that the procedure had been approved for outpatient coverage. I got the procedure, and my insurance denied the claim despite having the prior authorization. It was resubmitted and denied again, and I am currently waiting on an appeal.
My question is do I have any recourse if the appeal fails? I would not have proceeded with the procedure if I knew it wouldn’t have been covered, and I have never heard of a procedure being denied coverage after a PA has been obtained.
submitted by /u/swish_07
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I had a procedure done (vasectomy) which is excluded under my insurance plan. I decided to try to get it covered anyway as my wife and I carry a genetic defect that affects both of our children. My insurance suggested I attempt to get a prior authorization, and if that was denied to appeal the decision. We received a prior authorization, specifically stating that the procedure had been approved for outpatient coverage. I got the procedure, and my insurance denied the claim despite having the prior authorization. It was resubmitted and denied again, and I am currently waiting on an appeal. My question is do I have any recourse if the appeal fails? I would not have proceeded with the procedure if I knew it wouldn’t have been covered, and I have never heard of a procedure being denied coverage after a PA has been obtained.
submitted by /u/swish_07 [link] [comments]Read Morer/HealthInsurance