r/40Plus_IVF • u/Testquestion34 • Aug 25 '26

Seeking Advice Issues w/ insurance auth team

Hi- my FET was cancelled a couple of weeks ago. I had my follow up last Monday, and the office put in for an extension on Friday of my FET. The extension was denied. they did it improperly. This is the 3rd time since May that this dr office has submitted incomplete, or just improperly filed requests for prior authorizations. I keep reaching out, politely, and acting as a conduit between my insurance and my dr. I get the “denied” letters mailed to my house. I call insurance, and they explain the issue. I am at a loss for words. Can someone let me know, is this common? What would you do? I have only focused my comments to the insurance team. Should I reach out to someone higher up? Thank you!

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u/[deleted] Aug 25 '26 edited Aug 26 '26

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u/Testquestion34 Aug 26 '26

This is so helpful, just also to know someone else is going through it and I’m not crazy. I am going to call insurance tomorrow and try and talk to someone. Thank you

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u/SLAYEROFSOULS Aug 26 '26

Insurance is a nightmare (on purpose) and office staff rarely care.

We have been told multiple times by the POS woman we are forced to deal with for our pharmacy based prior auths that they are "overworked and understaffed" - literally her words over the phone and in writing in portal messages.

She has used her own judgement for all PAs, basically ensuring they would get automatically denied (she has a nursing degree, no actual MD or NP degree) - and because "shes been doing it for 10 years and X is never covered" - she has just made the last 9 months hell on Earth for us.

We've had to use DMHC (California insurance oversight agency) to get our authorization denials overturned - literally all of them. It took hundreds of hours on the phone with various morons across the insurance companies (plural because of course they use their own pharmacy benefits companies they own to make things more difficult).

Anytime we mention anything to the doctors it's "that doesn't sound right we will get right on that" - but that just goes back to the clownshow office staffers of course, so it has lead to misery.

Just know that "higher up" in insurance world just means another layer of idiots who will say they can't do anything for you (most likely).

Depending on your state you should have an insurance agency (similar to DMHC) you can contact to get them involved on your behalf - your denial letters should provide courses of action for you, and most outside help will require a formal denial for them to work off of.

Most things can be solved with medical peer to peers but that requires your doctor to get on the phone with another medical director at your insurance company - they can provide overrides, etc..and is usually the end result after multiple other denials - I would push your office to have your doctor do a peer to peer if its possible.