Need advice- my preauthorization request is going nowhere and my doctor’s office is missing deadlines (BCBS TX PPO)

Firstly, thanks for reading. I really dont know what to do.

I need orthognathic surgery and my insurance is a BCBS TX PPO plan. My doctor said they will definitely deny my preauthorization request the first time, but once my doctor appeals and does a peer-to-peer review it will be approved. I read a lot about getting this surgery approved and that seems to be the process with most people.

I had my consultation where they took scans and everything mid March. My preauthorization request was submitted ~2 weeks later. I got my denial letter mid-April, and after a week I called my doctor's office to ask about the status of my request. They gave me the email/number of their insurance coordinator and told me she would be handling my case. I emailed her, and never received an answer. I sent her another (polite & brief) message eventually in May, and she responded SUPER annoyed saying that she will reach out when she has updates. On the denial letter I noticed an appeal deadline 60 days later in June. As that date approached and passed, I sent a couple more emails and called her (she never answers), but radio silence.

Finally last Tuesday when I called, I actually got her on the phone! I asked what was happening in my case and she gave me the run around and did not acknowledge that the preauth had expired. She did say though that she was working on my case and submitting something ("I'm faxing them about your case today") that day! I got the vibe she didnt want to admit that she let the preauth expire, but was resubmitting a new request. However… Today I called my insurance and found out that nothing has been done or submitted on my case since the denial in April.

I got fed up in July when i was being ghosted so I scheduled a consult with another surgeon. This surgery is niche and of course I'm limited to those who take my insurance, so my only other option is to travel to a different city for this alternative surgeon. They are also in high demand so I was only able to get a consult for October. It's not ideal because this surgeon is not quite as specialized for my case, of course it's inconvenient to travel and pay those expenses and to live 3 hours away from the surgeon in case I need help post-op. So at least I am pursuing other options, but on Tuesday I felt so relieved that things might be progressing with my current surgeon.

Questions:

When a preauthorization request expires, that just means you need to resubmit it right? There's not some rule or waiting period against resubmitting the request and starting over?

If I go to this alternative surgeon, can I pursue both preauthorizations or do I have to decide at that point to move forward with only one surgeon?

Any thoughts or advice as to what is going on??? I know the insurance coordinator is just very busy, but this seems so odd. I'm afraid I annoyed the coordinator by reaching out after the denial and she is getting revenge by ghosting me. im tired

submitted by /u/unauthorizedcuddles
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