I will try to keep this as short as possible but I have never in my 15 years as an adult been as frustrated as I am right now.
My 4YO son needs an MRI per three doctors (oncologist, specialist, and our pediatrician) to rule out a malignant mass.
The specialist submitted the request for the MRI preauth and it was denied. I happened to be watching our portal closely, saw the denial, called our insurance, and was told because it was after hours the rep could not see the reason for denial and to call back in the morning.
I called back in the morning and was told the decision had already been overturned and I was given an authorization number as well as the dates the procedure was approved for (in line with the initial pre-auth request).
After a few days the portal was still showing denied so I called to make sure everything was still ok and was told it was never authorized to begin with. The rep could SEE the note from the previous rep saying the auth number but said they could definitively say the pre auth was still denied and had never been approved.
I asked for the reason and they said the doctor did not send the requested additional information within the 4 days so it resulted in an automatic denial but it still qualifies for an appeal.
Today I get 2 letters in the mail. One is a copy of the letter they sent to the doctor which has bolded all throughout it that if the requested additional information is not sent in the next THIRTY days it will result in automatic denial.
The other letter is the denial letter addressed to me stating that the MRI was denied because the doctor did not send the requested additional information within 4 days.
It’s only been 10 days since the initial preauth was even requested.
Beyond appealing (which our doctor has started) any advice on where I go from here? This test is time sensitive and I’m out of my depths.
submitted by /u/Blueone24
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I will try to keep this as short as possible but I have never in my 15 years as an adult been as frustrated as I am right now. My 4YO son needs an MRI per three doctors (oncologist, specialist, and our pediatrician) to rule out a malignant mass. The specialist submitted the request for the MRI preauth and it was denied. I happened to be watching our portal closely, saw the denial, called our insurance, and was told because it was after hours the rep could not see the reason for denial and to call back in the morning. I called back in the morning and was told the decision had already been overturned and I was given an authorization number as well as the dates the procedure was approved for (in line with the initial pre-auth request). After a few days the portal was still showing denied so I called to make sure everything was still ok and was told it was never authorized to begin with. The rep could SEE the note from the previous rep saying the auth number but said they could definitively say the pre auth was still denied and had never been approved. I asked for the reason and they said the doctor did not send the requested additional information within the 4 days so it resulted in an automatic denial but it still qualifies for an appeal. Today I get 2 letters in the mail. One is a copy of the letter they sent to the doctor which has bolded all throughout it that if the requested additional information is not sent in the next THIRTY days it will result in automatic denial. The other letter is the denial letter addressed to me stating that the MRI was denied because the doctor did not send the requested additional information within 4 days. It’s only been 10 days since the initial preauth was even requested. Beyond appealing (which our doctor has started) any advice on where I go from here? This test is time sensitive and I’m out of my depths.
submitted by /u/Blueone24 [link] [comments]Read Morer/HealthInsurance