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Unread 04-20-2015, 06:14 PM   #1
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Default prior auth denied - upmc help!

Hi, iv been on subs for awhile now, but ever since my insurace stopped because i turned 26 iv been having to pay out of pocket at the pharm. Luckly i was acepted for upmc for you insurace through ma welfare, but now i cant get them pre authorized at the pharm. Iv talked to my dr office and they said they faxed the forms, i then called upmc and they said they needed my dr to send them something verifying im in cousling, so after my next phycatrist app. I told them i needed them to send a verification to my dr they said they would. Then this morning i called my dr again they said they were waiting to receive the stuff from my phyc. and would fax it asap to the insurance co. But when i called the pharm some time later they said it still wouldnt go thu, uggh! So i called upmc and all they told me was they havnt recieved the necessary forms, and then i got a thing in the mail from upmc saying i was denied from the first time they tried cuz they didnt have paperwork from my behavoral health provider ( phyciatrist) and if i dont agree i should appeal there decision. should i do that of will my dr getting and sending the paperwork from my phyc dr. Change there decision? Also now my phyc. And sub dr wont answer my calls cuz its too late and i dont even know if there in the office everyday ( i doubt it) so i dont know what to do, im on my last strip, any advise??? Please and thank you!

Last edited by marvel; 04-20-2015 at 06:23 PM.. Reason: misspelled
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Unread 04-20-2015, 08:06 PM   #2
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Welcome to the current state of healthcare. I'm sorry you're having this trouble, but, unfortunately, it isn't that uncommon. What I would recommend is going to the Psych. office and get a copy of the paperwork to take to your doctor's office. I would also make a copy of it an fax it to the insurance company myself. I would then ask the doctor's office if they could send it along with any paperwork they need from the doctor himself while you are there in the office. Then, I would call the insurance company before leaving the doctor's office and make sure they have everything they require. Assuming they do, tell them you are heading to the Pharmacy and that you will call them back if you have any trouble. Be calm and don't want to burn any bridges.

It's unfortunate that you cannot depend on professionals like doctor's and Psych. offices to do what you pay them to do, but when it comes to something like Suboxone, it's always good to follow up to make sure they have.
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Unread 04-27-2015, 05:06 PM   #3
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