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

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]If you are able, I’d suggest researching the criteria to get the medicine in the first place, and also to continue it, and then write up an appeal on your own. You can probably find samples online. You might want to request supporting records from the physicians’ offices to support the appeal. Them take the whole thing, with a pen, along with a draft on a new flash drive, make an appointment, and give it to the doctor to sign and submit.

If that doesn’t work you need a significantly better doctor. [/quote]

I meet the criteria. I have called, and checked. [b]The doctor "does not do appeals.'[/b]

Finding a new PCP might take months. I might try Midi, but I don't know if insurance will let me start all over. [/quote]
Ok, this is a different situation than the office (I'm assuming the doctor doesn't submit these herself) refusing to submit the way the insurance is asking.

No advice, assuming that was clearly stated at the time you became her patient. If it wasn't, then you can point to that and say "no appeals" is a new policy that you should not be harmed by.[/quote]

Even if it did say that when OP joined the practice, I don’t think it should apply when the need for an appeal exists because of provider error.  It is generally expected that you fix a problem that you created even if you wouldn’t usually do the action that is the fix, assuming the action isn’t unsafe or unethical.

For example, I once ordered a dish in a restaurant, clearly specifying that the child it was for had a dairy allergy.  It came out with cheese sprinkled on it.  Even though the restaurant didn’t remake food, they made an exception and brought out a cheese free plate.  Because they made the error.

This happened due to a doctor’s error, the doctor needs to fix it by submitting the appeal.

[/quote]

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