New doctor?

Question

I have a chronic condition and have been going to one specialist for the entire duration of the condition. I'm still with pediatrics since their adult clinic is understaffed. I requested authorization to go this week and for the first time in over a decade, it was denied. Any tips on disputing this with the insurance company? I was told originally by the doctor's office that they no longer do new referrals to this hospital but that getting approved for follow-ups (given the duration of the condition) should not be a problem. I am overdue for an appointment and don't know what to do. The letter made it sound like they just want me out of pediatrics which makes sense but they said they've assigned me a doctor without my input. Help.

Answer 1

Call your insurance company and ask them to explain the specifics of the letter you received from them to you.

Answer 2

Well, you have to dispute based on the reason the insurance company denied.

If the provider is no longer in-network, likely you're going to have to either switch or pay out of pocket.