Prior Authorization Request Denied

In January, my wife's employer switched insurance providers to Anthem Blue Cross. Prior to this, I have been undergoing a multi-step treatment plan for severe sleep apnea, which involved an initial surgery 2.5 years ago, followed by 2 years of braces and expanders, and my doctors are finally ready for the final surgery, which they believe will immediately relieve my symptoms and reduce my sleep index from 80 to 10, a level that would be actually manageable with a CPAP or other treatment.

I was scheduled to have surgery May 15. Anthem received the prior authorization request about six weeks ago. They did not get back to us until last week, saying they were denying it as it was not deemed medically necessary. My doctor did a peer-to-peer review the next day, but yesterday we learned that, while they acknowledge the medical necessity, their rules require a step-wise approach (whatever that means). My doctor has submitted an appeal, but has told me that he expects it to take 6 weeks to hear from them.

However, my wife and I have jumped through so many hoops to arrange our schedules, finances, and additional childcare for the 4 weeks of recovery time. We are praying that that miraculously process this appeal and approve my procedure on Monday. Is there anything we can do to help expedite this with a positive outcome?

submitted by /u/Constant-Physics-744
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