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c/insurancefights·submitted 1 year ago by u/rekha_vestergaard

[Question] appeal — what am I missing here

Questionbranch of 6 comments

Genuine question, and the title is the question: appeal — what am I missing here. Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting their own criteria turned it around in eleven days. Asked for the policy bulletin by number and wrote the appeal against its criteria line by line.…

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6 comments, started 1 year ago
u/peak_area_peteanalytical3 points·1 year ago

What has been documented as tried, and for how long?

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u/camila_vasquez0 points·1 year ago

What has been documented as tried, and for how long?

Disagreeing with this line: the deadline runs from the letter date and treating it otherwise is expensive.

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[deleted]1 point·1 year ago

[deleted]

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u/osman_ferrari1 point·1 year ago

Employer plan or individual plan?

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u/blunt_coldbox_notes1 point·1 year ago

ask for the denial reason in writing, always

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u/rekha_vestergaardOP1 point·1 year ago

Correcting myself upthread: the deadline was 2 days, not the figure I gave.

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The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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