Prior Authorizations – If denied for eligibility criteria, can I lie and resubmit?
If a PA request is denied for a specific procedure, does that automatically deny future PA requests for the same procedure? As in, whoever is reviewing the newest PA request, will they be reviewing past requests as well?
For example, requesting PA for TMS. Most insurances usually require that you need to have tried at least 4 anti-depressants without remission. I've only tried 2, and spoke honestly to my doctor. For this reason, I'm anticipating that the PA request will be denied.
Once it's denied, if I went back to my doctor and lie and say that there's 2 more that I didn't tell him (for whatever reason), and the doctor resubmits the forms to insurance, will they essentially compare the first and second requests and see that there's an inconsistency?
I'm so stupid, I should've just lied in the first place and said that I've tried 4…
Any thoughts would be appreciated.
submitted by /u/cwamoon
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