Friday, January 2, 2015

Pre-Authorizations & Denials

Have you ever received a medical or pharmaceutical pre-authorization denial? Do not give up hope.

I used to aid others in seeking pre-authorizations as well as fighting denials for services. I am also a patient and have been on the receiving end of a denial or two.

I would just like to share that "denied" coverage is not the end. If you feel that the service(s) or medication is warranted, you and your physicians office should work together to appeal the denial.

Write your own personal appeal letter to the insurance pre-authorization department. Make your own case about why they should make an exception in coverage for you. Let your letter be accompanied by your physicians appeal. 

If it is denied again. Appeal to your employer's human resources. Get involved, stay involved, ask questions; even asking the hard questions.

If still denied, then inquire with your physician or pharmaceutical company about any patient assistance programs that might be available.

Be patient. Be persistent. Turn over every rock and pray all the while.

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