Prior Authorization being a pain

Prior Authorization being a pain

[Missouri, UMR/Optum RX] I (FtM) am beginning testosterone, which requires prior authorization. My doctor submitted a PA to my pharmacy insurance, which said it was not covered and to submit to medical insurance. My doctor has now submitted a PA twice to medical. The doctor sent one on the 4th and again on the 9th since medical insurance didn’t respond. Now it’s the 12th, and insurance still hasn’t responded. My insurance plan does exclude transition related health care – which is actually considered discrimination under Section 1557 of ACA. How do I know if my insurance was “grandfathered” under ACA and can use this exclusion vs. plan hasn’t updated their policies? To make things more interesting, I work for a school, and our insurance is self-funded through the school.

At this point, I just want my medication. It was initially prescribed to me in December. I could just go pay for it out of pocket, but can I submit a claim after the fact since it requires prior authorization? It seems like my options are to submit a claim, wait for it to be denied, them appeal it through the school and insurance. I’m not even sure how to approach appealing through my work. Do I just bother someone in HR? Our insurance booklet just lists addresses for both insurance and the school for submitting appeals. From what I understand, if the appeal is denied, then I can take that and file a complaint with OCR? Is this actually how it all works?

Tldr: Can I submit a claim for a prior authorization drug if I don’t wait for authorization? If denied, what is the actual process of appealing for self-funded insurances?