Didn’t get pre-authorization. Am I out of luck?

My in-network doctor prescribed a “durable medical equipment” device, which needs to be molded and fitted by another health care professional. There are no in-network providers of that type. My insurance company (Blue Cross, New York) told me I need preauthorization. My doctor refused to file the preauthorization request because he was not providing the device himself, and told me to get the healthcare professional who provides the device to file the preauth request. That person also refused to file it because (a) she doesn’t deal with insurance, and (b) she is not the one making the diagnosis, and so she would not have been able to include the relevant information in the preauth request to justify it. At this point I needed the device, so I paid for it and then filed a claim for reimbursement. Blue Cross has rejected both the claim and my appeal, stating that I was required to obtain prior authorization but did not.

Do I have any recourse here, and if so, what is it? I view it as a case of the insurance company demanding that I do something impossible in order to get the benefit I was entitled to (force my doctor to file a preauth request; I can’t force anyone to do anything) which means they made it impossible for me to obtain the benefit.

And what, if anything, should I have done differently here?

See also  Copulas explained