As the title says, our insurance denied a claim because no prior authorization ¶ was obtained. Here’s what happened: On July 5th, my husband got a call from his doctor, who had run some labs a few days before. The doctor made an emergency referral to hematology, and on 07/08, my husband was scheduled for an appointment on 07/11. The day before the appointment, the nurses called to let him know he was scheduled for a bone marrow biopsy during the visit. Apparently, our insurance (UMR) requires a PA for this procedure. All other claims related to this appointment, and others, have been approved. The facility and doctors are in-network, and we had already met our out-of-pocket maximum before all of this. Now we’re left with a $6,023 bill. Since we had already met our out-of-pocket max, and my husband was diagnosed with cancer from that biopsy, I’m wondering how to proceed with insurance.
Edit: I spoke with my insurance, and they will accept a retro PA but with a 50% reduction in coverage, up to $500. Based on the comments, it sounds like this is on the physician’s office for not handling the PA, so I’m going to let them deal with that loss.