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

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[quote=Anonymous][quote=Anonymous][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. The doctor "does not do appeals.'

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]

None of the foregoing is relevant to the suggested action, which is for you to prepare yourself what you want submitted, along with gathering the necessary supporting data to submit with it, then meeting the doctor to get it signed/submitted. 
[/quote]

The doctor isn't willing to sign and submit it, though. Would a bribe help? What would be a reasonable amount?[/quote]

First of all, the principle reason the doctor “doesn’t do appeals” is that they don’t want to put in the time and effort for free. Signing and submitting a prepared package end runs this, and the physician gets paid for an office visit.

Second, unless OP has done this exact thing, nobody knows what the doctor will say.

Third, is it the actual physician who is refusing to help or an underling/functionary paid to get in the way?  And what, if any, duty does the agreement between the physician and insurer say on this?[/quote]

I am very hesitant to do an office visit given the constant reminders of “ we do not do appeals”. I might be better off with MIDI or something? I am not sure. [/quote]

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