I was diagnosed with MS 16 years ago. I have been taking MS therapies that entire time. For the last four years my MS therapy is an infusion taken two times a year. My insurance company has always covered this (minus my deductible) in the past. Now they are refusing to pay for it. My doctor submitted the necessary paperwork and it was denied. Then my doctor’s office appealed the denial and it was also denied. They keep saying that the necessary information is not being provided even though the doctor’s office has sent it multiple times.
I have tried to call the insurance company but they just keep telling me that I’m not allowed to speak with anyone in the appeals department because they “don’t take phone calls there.” So, every time I call I’m just speaking with a rep who can’t tell me what needs to happen to get my prior authorization approved. My doctor’s office is also getting the run around. They told them that the appeals process has been exhausted and now we have to submit to an external review.
My infusion is now overdue because I can’t get this approval. I’m panicking and very upset (which is not great for MS unfortunately) . If it was only a few thousand dollars I would go ahead and have the infusion and hope they eventually agree to cover it, but it costs $150,000.
Does anyone here have any advice of who I can ask to speak with at the insurance company or what I can ask for to get this claim approved? Thank you for reading.
submitted by /u/sterilizedHSteacher
[link] [comments]I was diagnosed with MS 16 years ago. I have been taking MS therapies that entire time. For the last four years my MS therapy is an infusion taken two times a year. My insurance company has always covered this (minus my deductible) in the past. Now they are refusing to pay for it. My doctor submitted the necessary paperwork and it was denied. Then my doctor’s office appealed the denial and it was also denied. They keep saying that the necessary information is not being provided even though the doctor’s office has sent it multiple times. I have tried to call the insurance company but they just keep telling me that I’m not allowed to speak with anyone in the appeals department because they “don’t take phone calls there.” So, every time I call I’m just speaking with a rep who can’t tell me what needs to happen to get my prior authorization approved. My doctor’s office is also getting the run around. They told them that the appeals process has been exhausted and now we have to submit to an external review. My infusion is now overdue because I can’t get this approval. I’m panicking and very upset (which is not great for MS unfortunately) . If it was only a few thousand dollars I would go ahead and have the infusion and hope they eventually agree to cover it, but it costs $150,000. Does anyone here have any advice of who I can ask to speak with at the insurance company or what I can ask for to get this claim approved? Thank you for reading. submitted by /u/sterilizedHSteacher [link] [comments]Read Morer/HealthInsurance