Pre-Authorizations


(Ellen) #1

Hi,
I’m new here, but I was hoping to get some help. My daughter is type 1 (diagnosed 4 years ago). We live in a rural part of Montana where we need to travel for care. The closest Endo. is about 2 hours away in Idaho Falls, if we stay in state the closest one is 5 hours away. In late 2017 we switched to the Idaho Endo. which worked out nicely for ease of travel. We had insurance through my husband’s job, since then, beginning of 2018 it became too expensive to keep that insurance so we were able to get my daughter on our state Medicaid insurance. When we made the switch I let our doctor in Idaho know and gave them the updated insurance information and asked if there was anything else we needed to do. They said no, we can bill your MT Medicaid insurance. Since then her claims have been denied due to our Endo being an out of state provider. After many, many calls to the Medicaid insurance office, I finally found out today that there is no pre-authorization in place for our Endo. So we are responsible for the entire bill. When I asked how we initiate the pre-authorization, they told me that our Endo’s office has to contact them. When I told that to my Endo’s office, they told me that pre-auths are usually done in the beginning when insurance changes take place. I am so confused, frustrated and overwhelmed. Is there anything that I can do? Is there any help that anybody can offer?


(joe) #2

@MTFamily hi Ellen,

I am sorry I don’t have much to add but I wanted to bump this to the top of the feed in case someone here does.

I have had plenty of fights with my insurance company including a pre-authorization snafu many years ago. In that case, it was because a primary care physician was needed to OK “x-number” of visits to the “specialist”/ I think your situation is more complicated.

good luck hopefully someone can comment.