What do I do with this denial??
As I feared I got the dreaded denial letter----- BUT not for the reason I thought. I was denied due to the hospital not being a ASBS well qualified/center of excellence. There was nothing else on the letter except please submit additional information within 6 months for reconsideration of the preauthorization.
What really gets me is I had this conversation with the office person who handles authorizations and said I was concerned this may be the case from my research but I was not sure. She reassured me that they get auths all the time and it was fine.
Oh and they also said they only attempt authorizations one time.
Ok their error what does that mean? What do you think about this denial letter? Do you think there may have been other issues with my paperwork and this is the only one addressed or do they typically write all the reasons you are denied?
I really appreciate your help on this!! Does this mean I should appeal or just change locations of the surgery and possibly change surgeons within the same office. The WLS DR office has multiple providers that are ASBS approved. My DR is not on the list although the office he is with is approved and so are some of the hospitals. I am totally ok with changing locations and changing DRs.
Paul, thanks. I have GEHA (government) so I am covered in any state including TX. I have researched DRs (COE) there and there are none in Austin but some in San Antonio. I am actually concerned about moving and GEHA becoming my secondary insurance due to me getting employment in TX. I am self employed currently so GEHA is my primary.
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