Do I have any legal recourse because the doctor’s office failed to obtain prior authorization for my antidepressant, so now I’m facing withdrawal?

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Do I have any legal recourse because the doctor’s office failed to obtain prior authorization for my antidepressant, so now I’m facing withdrawal?

My doctor switched my anti-depressant due to side effects. I filled the new medication and transitioned without heavy withdrawal. I received a letter from my insurance company about a week after I filled my prescription but unfortunately my insurance requires a prior authorization before they will pay for any refills. I immediately contacted my doctor’s office and informed them that they needed to call the insurance and start the process of getting the authorization and also had the pharmacy send them a request as well. The office failed to start the process and I am now facing horrible withdwals and because the cost, unable to pay out of pocket.

Asked on February 13, 2019 under Malpractice Law, Michigan

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 2 years ago | Contributor

No, you unfortunately do not have any recourse. Ultimately, it is your responsibility, as the insured, to make sure that the requirements of your insurance are met. You needed to follow up and make sure there was prior authorization, or not purchase the medication until you saw proof of authorization. The doctor's office is not liable for not following the requirments of your insurance.


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