Is it wrong for a patient apply for a prior auth themselves?

In mid August, my doctor's assistant filed a PA on my behalf that was denied for the name-brand of an anti-anxiety med I'm on (yes, I am one of those folks who swears generic and name-brand are NOT the same).

However, the denial letter stated that the provider OR patient could file an appeal, which I didn't even notice until I read it several times. So…I called in and appealed. I merely explained over the phone my complaints with the generic, which only took several minutes…but what I didn't realize was my doc's assistant had done the same thing as well.

I guess our intentional tag-teaming worked because sure enough, the denial was reversed!

So: what I'm wondering in the aftermath of this experience is whether it's unethical or disrespectful to take things a step further in the future and initiate the prior authorization process as a patient, knowing that nowadays, you have no paperwork to fill out and really just need your Insurance Member ID and provider's NPI, which is public record.

Also, I'm in my 20s, live in North Philly and worked almost full time for Instacart before I got burned out. Having coverage for the name-brand is saving so much room in my budget to finance and focus on fun career projects.

submitted by /u/VirginiaWriter
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See also  Do patients have a right under HIPAA to access documentation on prior authorization denials, specifically license information for the insurance-side physician who denied the claim?