Prior Authorization Problems

Insurers often require prior authorization for expensive services such as PET scans, surgery, immunotherapy and some oral cancer drugs. Delays happen when forms are incomplete, when the insurer asks for more medical records or when the requested treatment does not match the plan's internal guidelines. Because mesothelioma is rare, reviewers may not be familiar with standard treatment approaches. Sometimes the request simply sits in a queue. Asking your doctor's office when the request was sent and what the insurer has asked for helps you find out where things stand.

Your doctor can often ask for an expedited or urgent review when waiting could seriously harm your health. Many plans must decide urgent requests faster than routine ones. If a request is denied, your doctor can ask for a peer-to-peer review, a conversation with the insurer's medical reviewer to explain why the treatment is needed. Supporting evidence, such as treatment guidelines and pathology reports, strengthens the case. Stay in touch with the clinic's authorization staff and ask them to tell you when a decision comes in.

Write down every call with your insurer, including the date, the person's name and a reference number. Save copies of letters and emails. If you are told something different by different representatives, your notes help you escalate the issue to a supervisor. Records also matter if you later need to file a formal appeal or complaint with your state insurance department. Share your notes with the clinic's authorization team so everyone works from the same information. If problems keep happening, ask the clinic whether a supervisor or patient advocate can help resolve repeated delays with your insurer.

1. 1

   Ask your doctor's office whether an authorization request was sent and on what date.

2. 2

   Request an expedited review if waiting for treatment could harm your health.

3. 3

   Ask your oncologist to request a peer-to-peer review if the request is denied.

4. 4

   Log every insurance call with the date, representative name and reference number.