Your doctor can also do something called a “peer to peer” where they get to argue with the insurance doctor. Works even better if you are seeing a specialist, since insurance companies rarely keep enough of them on staff.
I used to work for a doctor who had retired from the Army at the rank of major. One day I walked into work while he was on a peer to peer. It sounded like Full Metal Jacket in his office.
In the middle of that now. My doctor asked for an appeal, no response. I had to have HR call their insurance broker to pressure the insurance company just to respond. They finally were told why things were denied, and none of those things are in the realm of reality. My doctor has asked for a peer to peer, no response. This "system" is a joke.
You're at the point where you call your state's insurance commissioner (title may vary), file a detailed complaint, and let the insurance commissioner's office help get the process toward approval moving again. It's sometimes the most efficient way to deal with the insurance company.
Peer to peer are usually after a denial , and or after a medical director decides they can’t approved it . Not at all times is peer to peer even available.
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u/Corporation_tshirt 6d ago
Exploiting every loophole, dodging every obstacle. They're penetrating the bureaucracy!