Prior Authorization Craziness
- Thread starter somarco
- Start date
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- Tags
- prior authorization
- 901
So, what does this remind me of...? Hmmm...thinking....WAIT I got it...!
Me on the phone or chat for countless hours with an insurance company listing to that damn wait music, being shuffled from one department to another and THEN them dropping the call or if a overseas call center them just hanging up on me.
Me on the phone or chat for countless hours with an insurance company listing to that damn wait music, being shuffled from one department to another and THEN them dropping the call or if a overseas call center them just hanging up on me.
- 1,255
That’s me trying to get paid on SilverScripts after they billed me for writing their PDP’s from hell. I’m such a nice guy…So, what does this remind me of...? Hmmm...thinking....WAIT I got it...!
Me on the phone or chat for countless hours with an insurance company listing to that damn wait music, being shuffled from one department to another and THEN them dropping the call or if a overseas call center them just hanging up on me.
- 1,745
Asking for suggestions/experience.
I have not yet been notified of a situation like this or been asked to help. Any shared experience is welcome. Generally, I don't intervene except to suggest where to get help when there are claims issues.
I received an emotional email over the weekend from a client. The cardiologist's test recently ordered after a client's ER visit had to be cancelled last minute as prior approval was denied.
I am familiar with the cardiologist in a well respected hospital chain with cardio specialists and a hospital just for heart and vascular cases. Now that I think about it, the insurance carrier is owned by the hospital chain.
Area sales rep asked if the case manager had been notified and for the patient to contact member services to request an appeal. I don't know, and the client didn't mention if the doctor will automatically appeal the rejection.
I have not yet been notified of a situation like this or been asked to help. Any shared experience is welcome. Generally, I don't intervene except to suggest where to get help when there are claims issues.
I received an emotional email over the weekend from a client. The cardiologist's test recently ordered after a client's ER visit had to be cancelled last minute as prior approval was denied.
I am familiar with the cardiologist in a well respected hospital chain with cardio specialists and a hospital just for heart and vascular cases. Now that I think about it, the insurance carrier is owned by the hospital chain.
Area sales rep asked if the case manager had been notified and for the patient to contact member services to request an appeal. I don't know, and the client didn't mention if the doctor will automatically appeal the rejection.
- Thread starter
- #6
Because of HIPAA you may find it difficult/impossible to intervene. Unfortunately, most, if not all, MCO contracts require arbitration before getting outside health.
Appeals are usually handled by the provider, not the patient.
That being said, social media may be the most effective resource. Carriers monitor SM for any mention, especially negative feedback.
News organizations also comb SM looking for new content.
Appeals are usually handled by the provider, not the patient.
That being said, social media may be the most effective resource. Carriers monitor SM for any mention, especially negative feedback.
News organizations also comb SM looking for new content.
- 2,110
Another avenue would be to have your client call his MBO. Doesn't matter what type plan he has.
Some states have their own MBO. I know that GA has one for nursing homes and those suckers don't play around.
Here's a link to an article on MBOs. Don't know a thing about these Fair Square people but it's a better article than you'll get on cms.gov
https://fairsquaremedicare.com/articles/medicare-beneficiary-ombudsman-explained
Some states have their own MBO. I know that GA has one for nursing homes and those suckers don't play around.
Here's a link to an article on MBOs. Don't know a thing about these Fair Square people but it's a better article than you'll get on cms.gov
https://fairsquaremedicare.com/articles/medicare-beneficiary-ombudsman-explained
ValeRosso
Guru
- 523
So infuriating. And you know they do it on purpose
AgentGeneral
Guru
- 281
Its gonna be me soon if I don't get paid on T65s that are well overdue and ripe
