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Spinraza pre-authorization
I may be wishful thinking here, but has anyone gotten their pre-authorization for Spinraza approved WITHOUT a yearly physical therapy evaluation?
I’m giving it a shot and seeing if my insurance will take last year’s evaluation but I don’t know. The Covid numbers are on the rise in my area and I’d rather avoid the hospital if possible. I’m guessing they’ll originally deny me in which case I’ll appeal. The case manager said it happened once with another patient when all this started, and after appealing, insurance approved. We’ll see. Fingers crossed.
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3 Replies
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I just got a letter saying I’m approved for next year and I haven’t seen my doctors in a while. I saw my main neurologist in November of last year and the MDA clinic PA in January of this year. I was surprised because I had been getting my approvals from December to December, but this one is for October to October next year. The approval goes through my neurologist, not the PA, so I had two approvals from that November visit. I didn’t ask them to submit it early or anything. Only thing I can think of why they did it early is my Biogen FAM got reassigned to a new job so she might’ve had them do it ahead of time while she was still involved.
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Usually my clinic calls to schedule my annual meeting with the neurologist and physical therapy assessment but I haven’t heard from them, so wondering when I need to reach out. Does insurance actually need an assessment? I was under the impression it was more a formality but not a necessity. Probably varies by insurance too.
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I have always needed a physical therapy evaluation before insurance could authorize— but good news! They accepted my request today and are forgoing PT for the new yearly cycle. Here I was with my boxing gloves on ready to put up a fight lol. I’m so relieved.
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