I can corroborate gently’s comment on how doctors vary in their skill at navigating prior authorization. My first osteoporosis specialist, a rheumatologist, required weeks to obtain approval for Tymlos. When I’d been on it for three months, Cigna revoked my PA and she didn’t know what to do. They wanted me to go on teriparatide even though I’d be approved for two years of Tymlos. I had to lead the approval process, telling them what the insurance company required, right down to the dose to request. They fumbled the request and kept submitting the incorrect dosage. It took two months and many calls to Cigna and the doctor to get it sorted.

Contrast this to my experience with the endocrinologist I began seeing shortly after. She obtained approval to start Evenity within one week.

There is an appeal process for refusals. 80% are overturned on appeal. The doctor often has to submit additional paperwork or do a peer review first. It’s time consuming and annoying. My husband just went through this with rotator cuff surgery. Cigna sent three denial letters in total. It took several weeks for his surgeon to get approval and he had to call his office repeatedly to remind them to submit the required paperwork. In the end, Cigna approved and he had the surgery. It’s an annoying part of the medical system that we patients have to endure.

Make sure you call your doctor’s office to ensure they follow up. Learn what the appeal process is and get on your doctor to follow up. You shouldn’t have to do this but it’s your health at stake. I hope you can get this over the finish line. I know it’s hard when you are in pain every day. Hang in there.