Insurance won’t interface with pre-auth company to fix clerical error
Hi all! Really hoping someone could give me some advice on this mess of a situation. I’m incredibly frustrated, and critical medical care has been delayed by more than two months because this issue remains unresolved.
Dramatis personae:
Health insurance company (“Insurance”)
Administrative professional at doctor’s office; I.e. a designated insurance person at the office, not the doctor themself (“Provider”)
3rd party company who handles pre-authorization requests for Insurance (“Company”)
me (at my whit’s end)
Problem: Provider cannot submit pre-authorization request to Insurance via Company because Company has erroneously designated me in their system as “inactive”.
Provider called Company, who said that they cannot authorize changing my status to Active without Insurance’s approval. Fair enough.
Provider called Insurance to pass on this instruction (and at the same time confirmed that I am an active subscriber). Insurance has since told Provider that they are unable to get through to Company, although Provider has been able to get through three times.
Process has been in stalemate for 2 months because Provider knows the problem, but can’t wrangle Insurance and Company into line to get together and fix it.
My frustrations:
it is very clear what the problem is (error in Company’s system) but this apparently never happens so no one knows how to navigate the protocol for fixing it.
I called Insurance, they told me they would follow up with Provider but that there was nothing I could do to push things from a patient side since I don’t have any involvement with Company.
I am used to having to advocate for myself to navigate the medical bureaucracy, but this seems to be outside of my sphere of influence. At the same time, I don’t feel like the parties involved are trying hard enough to get this resolved (maybe Provider needs to be firmer with insurance, or try to get them all on a call together. Or Insurance needs to try harder to get through to Company). In general, I feel like the onus/responsibility is being passed around cyclically and nothing is actually getting accomplished, or there must be a lapse in communication somewhere.
Does anyone have any advice for this situation? Any recommendations for how I might further escalate this? I feel completely helpless when I think about this; it’s such a big system, and I feel like I’ve fallen through the cracks without a clue how to dig myself out.