By skyforbes I have Simply Healthcare (Medicaid, Florida). I’ve been prescribed Accutane for cystic acne, but I have very difficult veins. My dermatologist requires monthly labs before refilling the script, but Quest and LabCorp have repeatedly failed to get my blood after multiple attempts. It’s physically and mentally draining.
On May 15, I contacted Simply and was told I could go to a hospital outpatient lab if my provider submitted a referral and a prior authorization. They gave me the exact fax number and told me it just needed to be approved before going.
I gave that info to my dermatologist’s office weeks ago. They only just faxed the referral, but not the prior auth. When I finally got a follow up, they told me the hospital “said they don’t take your insurance” and “is a walk in” which I know is false because I’d called the hospital days prior asking and confirming.
Simply confirmed again today that the prior authorization is all that’s needed. But my derm’s office doesn’t answer the phone (even when they called me at 2:00PM and said to call my insurance and I said I’d call and get back to them right away), and they don’t even call back or fax this authorization.
They just say, “We can’t prescribe Accutane without labs,” and don’t offer any workaround or even acknowledge how long I’ve been trying.
I’ve now been off medication since my last appointment — even though I’ve followed every instruction, called both the insurance and lab myself, and even gave them the fax number. I also asked them to mark the request as urgent. I’ve left voicemails, tried to speak to the office manager (she was “busy”), and messaged through the patient portal which is limited to 250 characters.
Do I have any recourse? Can I report them? Can I escalate this to anyone? Or should I try to switch providers, even though I’m halfway through treatment?
Any advice or next steps are appreciated. This whole thing has taken over my life.
TL;DR:
I’m on Medicaid in Florida and halfway through Accutane. My derm requires monthly labs but Quest/LabCorp can’t draw my blood due to difficult veins. My insurance said I can go to a hospital lab if the derm submits a referral + prior authorization — but the office still hasn’t sent the prior auth, and now I’ve been off meds for weeks. They won’t offer a workaround, and I’m stuck. What can I do?