Last year I was in a position where I had to refill several necessary medications before receiving my health insurance information (ID number, etc) from my employer’s new provider. I was advised, both in a general enrollment conformation email as well as directly over the phone, to pay out of pocket and have them reimbursed. This worked for most of them, but one of the prescriptions required prior authorization (totally slipped my mind – I’ve been on it for five years and rarely had to get it reapproved) so the reimbursement was denied. I tried getting prior authorization after the denial, but then the insurance company told me they could not apply it retroactively.
They denied my first appeal, but with a response that tells me they didn’t understand what I was saying at all, so I’m planning to escalate it. But before I do, I’m wondering if I’m correct in thinking I have a case here? I don’t think the provider could have had it authorized without an ID number (I tried calling them to ask and I never heard back), and at no point did any of the advice to have it reimbursed come with a warning about prior authorizations not being retroactively applicable to reimbursement claims.
State: NC
submitted by /u/sxiz
[link] [comments]
Last year I was in a position where I had to refill several necessary medications before receiving my health insurance information (ID number, etc) from my employer’s new provider. I was advised, both in a general enrollment conformation email as well as directly over the phone, to pay out of pocket and have them reimbursed. This worked for most of them, but one of the prescriptions required prior authorization (totally slipped my mind – I’ve been on it for five years and rarely had to get it reapproved) so the reimbursement was denied. I tried getting prior authorization after the denial, but then the insurance company told me they could not apply it retroactively. They denied my first appeal, but with a response that tells me they didn’t understand what I was saying at all, so I’m planning to escalate it. But before I do, I’m wondering if I’m correct in thinking I have a case here? I don’t think the provider could have had it authorized without an ID number (I tried calling them to ask and I never heard back), and at no point did any of the advice to have it reimbursed come with a warning about prior authorizations not being retroactively applicable to reimbursement claims. State: NC
submitted by /u/sxiz [link] [comments]Read Morer/HealthInsurance