Prior authorization delayed b/c of doctors

[jayden1234522]

My imaging center opened an authorization case and they contacted the doctors office for medical records as it was requested by insurance(aetna)'s authorization handling company(Evicore).

However the medical records team never reply to voicemail, doesnt answer phone calls and they claim that they never received any fax. I found out recently that they worked from home - idk how long.

It's beem two weeks since my authorization has been put on hold.. medical records team sent me the medical records to me but not to doctors. I got scared off by seeing how easily sent the documents over to my email and emailed them back saying they shouldn't be just emailing to a random gmails.

• they respond to emails-

Now they claim that other providers/imaging center must have a hippa form signed but still they have not received any fax. They don't answer my question on why they haven't checked voicemail.

I found that providers don't need Hippa forms for each other but would definitely need one to send to random emails like mine.

I need to get an MRI done.. can i sue this doctor's office? What can i do to get this authorization approved? Just going to another doctor is the only option?

Please help.

 

[jesusistheultimatewarrior]

@jayden1234522 Just know this chaos is caused by insurance and doctors are cogs in a bad system along with you

Whether you can sue a doctor is a legal question, so consider r/AskLawyers

You can always get a new doctor that is more responsive

 

[thewordiswisdom]

@jayden1234522 It's been 2 weeks. Sometimes they can take over a month.

 

[cea]

@jayden1234522 Sometimes ordering providers also outsource their prior authorizations. They use call centers from India to do their authorizations for their patients. They could be doing this but who knows. I recommend finding another office who can help but just know if one is pending already your current doctor may need to cancel it before a new one can be initiated by another doctor.