Complaint Regarding Mishandling of…
Complaint Regarding Mishandling of Prior Authorization and Appeal.
I am writing to formally complain about the way my prior authorization request and subsequent appeal were handled by your medical office.
Your office submitted a prior authorization request to my medical insurance company, but the request was denied because not all of the required medical documentation was submitted.
It took approximately four days for your office to review the situation and determine what additional documentation was required. During this time, I called your office several times and specifically informed your staff that the insurance company had not received all of the necessary documents. Despite my repeated calls and concerns, I received messages and phone calls from your office telling me that I already had an approval and that everything had been taken care of.
I also specifically requested that a manager call me to discuss this situation. However, despite my request, no manager ever called me back and when I asked for the name of the manager the person I was speaking with hung up on me.
Eventually, your office submitted an appeal. Unfortunately, the appeal was also denied. According to the insurance company, the appeal did not adequately explain why the procedure was medically necessary. It also did not provide sufficient information about whether any non-surgical treatment had previously been performed for my vein condition and, if so, what treatment was provided and whether it was effective.
I am very concerned that the denial may have been caused, at least in part, by incomplete or insufficient documentation submitted by your office. I repeatedly contacted your office and clearly communicated that the insurance company was missing documents, but I was reassured that I had already received approval.
After the appeal was denied, instead of receiving a call from a manager to discuss the situation and how to resolve the insurance denial, I received two messages asking me to call the office to discuss other payment options.
I find this extremely concerning and frustrating. My priority is to receive medically necessary treatment and to have my insurance authorization handled correctly. I do not believe I should be directed toward discussing alternative payment arrangements before the medical office has properly addressed the documentation issues that led to the insurance denial.
This situation has caused unnecessary delays, stress, and uncertainty regarding my medical treatment. I found this behavior very unprofessional and inappropriate.
Sincerely
Oleg Kostiuk
Venice FL
2 september 2026
Omdöme utan inbjudan