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@PDXyogini@toot.cat

Post #2097464

2026-04-29 21:08 UTC

UGH!!! I'm due to have a treatment for my severely degenerated right knee that is long overdue for a patellar femoral replacement, but "surprise osteoporosis" pushed everything back at least a year. Last year my doctor got this treatment approved for every 3 months instead of 6 months. This was a big improvement since it stops being effective at around 3 months and 2 weeks. Meaning I was extra miserable for 2 months and 2 weeks until I could get treatment again. The prior authorization for it expired in February, so I got my orthopedist's medical assistant on the case to get a new one so I'm on track to get another treatment next month. Get those balls all rolling along since the appointment can't be scheduled until the speciality pharmacy gives me a date that they will deliver the medication to the orthopedist's office. I got a text today that I'd be receiving a letter explaining why the PA was rejected. I'm on hold, a second time since the first time I was disconnected after 17 minutes, waiting to have the first operator talk to the PA department. I'm not waiting for a letter to make its way through the insurance and postal systems. After another 17 minutes I found out that the new application checked "no" on a box when they should have checked "yes". I've relayed this back to the medical assistant and, hopefully, all the balls are rolling along again. Gah! I'm exhausted by this timeline. And we have excellent insurance provided through my spouse's very large technology corporation.

Replies (2)

  • @PDXyogini@toot.cat 2026-04-30 00:26

    Got a text that the appeal of the denial of the PA is under review. Should be fine now that the boxes are correctly checked. I’m sure I saved two weeks of delay by getting on the phone.

    Open ##2273101

  • @toolbear@tech.lgbt 2026-04-29 21:54

    @PDXyogini@toot.cat I'm sorry you're up against that. Living through a collapse of social safety nets is so frustrating. Hopefully they don't put any AI mediated stuff in your way.

    Open ##2273102