Practice failed to complete multiple PAs for Meds, about to initiate grievance process…HELP!!
As stated above, the nursing staff repeatedly refused to complete Prior Authorizations for a medication Each PA was denied because the staff failed to include requested info (e.g., chart notes, etc.) My insurance company (BCBS) followed up in each instance, listing the required info. BUT the lazy staff simply never provided it, resulting in a denials of all PAs.
I went through this THREE times with them, all with the same final result. Because the PAs were denied, I was forced to pay at out of pocket for MONTHS as a result of the staff’s laziness. Had they completed the PA, my meds would have been covered.
So it’s solely due to the practice’s refusal to complete PAs that my meds weren’t covered. My insurance has confirmed this fact.
I am now about to enter the grievance process, which is going to be a major pain.
Here’s my question: is it likely that my insurance will agree to cover the meds (after the fact; via reimbursement) since the whole issue is a result of the practice’s staff failing to do their job? BCBS had no wrongdoing here, so I’m wondering how likely it is that my grievance would even be successful. I’m also struggling to understand how ERISA process fits into all this.
Your thoughts/experiences? Ive spent so much time dealing with this and am ready to scream.
TL;DR Nursing staff at medical practice repeatedly failed to complete multiple PAs, which were denied as a result and forced me to pay for meds that would have otherwise been covered, had they actually completed the PAs. How likely is it that my insurance co (BCBS) will agree to reimburse me as the practice is entirely at fault and the ins co did nothing wrong?