Wiki Prior Auth after DOS

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chughes04

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I am trying to get authorization for an out of network office visit. Prior auth was not obtained prior to the visit. Has anyone had any luck getting auth after the fact. Also, if you would have a sample appeal letter or steps to follow to try and get the visit paid would be appreciated.
 
This can be an administrative mess and easily prevented in the first place. Not all insurance companies will allow the retro-auth process, and you can still go to all the work in making sure they receive the necessary forms and documents and still get the denial. I know of one major insurance company in particular that in spite of "allowing" the retroauth process to take place, ultimately there will be denial rendered. Can't stress enough the importance of making sure the pre-certs and pre-auths are acquired ahead of the procedures. This has been my experience.

---Suzanne E. Byrum
 
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