anthompson87
New member
tl;dr: Can I personally appeal the denied prior authorization for my son’s speciality medication, or must it be done by his doctor?
Long Version: My son has a genetic growth condition and requires growth hormone treatment until the conclusion of puberty. This treatment is essential to his growth, development of both muscle mass and bone density, reduces hypoglycemia and more. He began growth hormone treatment around his 2nd birthday (approx 9 years ago) and has significantly benefited from the it.
About 8 years ago, I switched jobs and within 2 years, the company went out of business. Due to my profession, it was difficult to find work in my industry and with the IT system I’ve built my career on. As a result, I worked for 2 other companies before landing the perfect role almost a year ago.
My son’s doctor has expressed a lot of frustration regarding the paperwork that has been done to authorize my son’s medication each time I changed employers Counting my initial and current employer, she’s had to submit prior authorizations 5x. She has said that if I were lose my job or find new employment, she will would no longer treat my son. While I completely understand her frustrations, this is only the 2nd time we’ve been denied and have had to appeal a decision, the 1st of which was eventually approved by an external independent review.
When the prior authorization was denied with my current employer, it was never appealed because one wasn’t submitted within the 180 day time frame. A 2nd Prior Authorization was submitted and denied 6 weeks ago. Since then, I’ve been unable to get my son’s doctor to submit the appeal. All but 1 attempt to obtain an update have gone unanswered. The one response I did get was, “I’ll look into and get back to you.” This was on Monday (a month after the denial)
, and I’ve yet to hear back and my requests for an update have gone unanswered.
My son has been off his growth hormone treatment for almost 8 months now and started puberty (meaning the window of treatment is quickly closing). Meanwhile, the drug manufacturer may be able to provide him with interim medication during the appeal process, but a copy of the appeal is needed for them to assist us, which has yet to be submitted.
I feel like I’m at the mercy of his doctor, who I feel is punishing us due to her frustration over having to get the medication approved 5x. Regardless of her frustrations with me, my son shouldn’t have to go without treatment because of my job history.
Furthermore, there isn’t a single doctor who treats his condition within 500 miles of us. In fact, there are only a handful of doctors in the world that do.
I’m at my wits end here, which leads me to my question. Am I able to appeal the denied prior authorization for his speciality medication, or must it be done by my son’s doctor? I have all of the notes and verbiage needed to do it on my own, thanks to the detailed information on the patient portal if I’m permitted in o submit the appeal.
TIA!
Long Version: My son has a genetic growth condition and requires growth hormone treatment until the conclusion of puberty. This treatment is essential to his growth, development of both muscle mass and bone density, reduces hypoglycemia and more. He began growth hormone treatment around his 2nd birthday (approx 9 years ago) and has significantly benefited from the it.
About 8 years ago, I switched jobs and within 2 years, the company went out of business. Due to my profession, it was difficult to find work in my industry and with the IT system I’ve built my career on. As a result, I worked for 2 other companies before landing the perfect role almost a year ago.
My son’s doctor has expressed a lot of frustration regarding the paperwork that has been done to authorize my son’s medication each time I changed employers Counting my initial and current employer, she’s had to submit prior authorizations 5x. She has said that if I were lose my job or find new employment, she will would no longer treat my son. While I completely understand her frustrations, this is only the 2nd time we’ve been denied and have had to appeal a decision, the 1st of which was eventually approved by an external independent review.
When the prior authorization was denied with my current employer, it was never appealed because one wasn’t submitted within the 180 day time frame. A 2nd Prior Authorization was submitted and denied 6 weeks ago. Since then, I’ve been unable to get my son’s doctor to submit the appeal. All but 1 attempt to obtain an update have gone unanswered. The one response I did get was, “I’ll look into and get back to you.” This was on Monday (a month after the denial)
, and I’ve yet to hear back and my requests for an update have gone unanswered.
My son has been off his growth hormone treatment for almost 8 months now and started puberty (meaning the window of treatment is quickly closing). Meanwhile, the drug manufacturer may be able to provide him with interim medication during the appeal process, but a copy of the appeal is needed for them to assist us, which has yet to be submitted.
I feel like I’m at the mercy of his doctor, who I feel is punishing us due to her frustration over having to get the medication approved 5x. Regardless of her frustrations with me, my son shouldn’t have to go without treatment because of my job history.
Furthermore, there isn’t a single doctor who treats his condition within 500 miles of us. In fact, there are only a handful of doctors in the world that do.
I’m at my wits end here, which leads me to my question. Am I able to appeal the denied prior authorization for his speciality medication, or must it be done by my son’s doctor? I have all of the notes and verbiage needed to do it on my own, thanks to the detailed information on the patient portal if I’m permitted in o submit the appeal.
TIA!