Her staff, however, are worse than useless. I was in on March 5th, and the doctor ordered a second round of physical therapy for me, this time for my neck/shoulders/upper back instead of my knee. I WATCHED her mark the referral as "urgent" and "requires prior authorization" on my electronic chart. She wrote in the description that it needed to be done urgently, as I have only 3 sessions left of physical therapy, and if my additional sessions are not approved by my health plan, then my PT treatment plan needs to change immediately--as in, this is Tuesday, and my next visit is Monday.
Since the doctor's office was having issues with their computers and electronic charting the day I was in, I called Wednesday late in the day to see if my health plan had received the request yet, and was told they had not. The re said that my physical therapist could fill out the authorization request instead of my doctor. The PT's office says they can't. My doctor's office says they have sent the PA request, but health plan still has no record of it two weeks later. I keep calling people and checking on this, trying to get the PT's office to fill out the form, but they refuse because they're "not a doctor's office." My doctor's office says they've sent the referral, but the can't seem to figure out that I want them to fill out the form they were told to fill out: the prior authorization request.
In the meantime while waiting for all this, I have received four different referrals from the doctor's office, sending me to PT--for my knee. Finally I got another one, this time for my neck. They also apparently "keep faxing it to the PT's office but it keeps not going through." Even though the PT's office has been calling the referral dept and asking why they're sending additional identical referrals, and trying so very hard to get a prior auth form sent for me.
I'm going in for my last PT visit next week, and according to two different service reps at the heath plan, the longer I go between the last session and the health plan getting the prior auth request for more, the less likely they are to approve it--because in their minds I will have been falling behind in vital treatment and therefore getting less out of subsequent treatments, even though it's supposed to be for a different part of me.
At this point, I think my only option is to print off the form myself, take it into my doctor's office, have her fill it out, and fax it to the health plan myself. I told my PT's office that the referral dept doesn't know their ass from their elbow, and they offered that if I can get my doctor to fill out the form and give it back directly to me then they will fax it for me so we can skip the staff entirely.
PT has been going great, BTW, I can walk like a normal person a lot more now, and I even have used stairs for the first time in ages. I'm starting to have an easier time breathing, since my neck and back issues have really aggravated my asthma. I have a long way to go and with my medical maladies I may never be completely well, but I'm starting to have hope that I may be a mostly-functional human being again! So that's nice :)