Reply to Can someone help with this doctor and prior authorization snafu?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]It is a continuation of Rx. It is initial request under this plan. I can see why your doctor won’t say it’s an initial prescription because that contradicts your medical records. [/quote]

I called the insurance directly and they said it should be initial. Continuation only applies if you have reached maintenance dose, and I have not. I have only been on it for 3 months. [/quote]

That sounds like a plan specific definition. I’d be asking for that in writing because the definition clearly is not how your previous plan used that terminology and not how your doctor understands the terminology. And as someone who litigated a lot of insurance denials, it’s not a definition that is intuitive to me but plans are allowed to have their own definitions.

It is odd to me that a doctor in network who provides this treatment doesn’t know the terminology. No judgement about the doctor. Just seems like a communication breakdown or even an insurance processing issue. [/quote]

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