Next steps help with Anthem

Background: Anthem has been giving me run around on getting new Abrysvo vaccine for unborn child. Vaccine has a specific time frame to get while pregnant. It is currently non-formulary as it came out this year. By the new year it will be too late for me to get the vaccine for my child. Doctor has recommended it but cannot provide it as it is short supply. Only a few pharmacies in the area have it and only give it to women 32-36 weeks pregnant or senior citizens.

First Anthem tells me to get a prescription. Pharmacy, OBGYN and myself thought that was weird but Anthem said they’d cover it 100% if I did that. Apparently that was wrong because they gave me the same non formulary answer after that. I asked if it was a pre authorization issue and they said no.

So I filed an expedited appeal. They didn’t contact me as they said but I followed up in 72 hours to find out that the appeal was ‘cancelled’ and have no idea why. Nothing on my patient portal and no contact from Anthem. I finally get them to email me the appeal decision and they ‘withdrew’ my appeal to ‘preserve my appeal rights’ because now they want a pre authorization. At this point I’m running out of time to get this vaccine. Will contact OBGYN about authorization but this is ridiculous run around.

Can I pay out of pocket and submit a claim later? And file an appeal later when they undoubtedly deny me again?

submitted by /u/puppy_sneaks3711
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