does denial actually matter or is it forum lore at this point
does denial actually matter or is it forum lore at this point. I would rather ask a basic question now than get this wrong quietly for two months. External review was the thing that finally worked. I did not know it existed until a thread on this board. Documented eighteen months of what had been tried in a one-page…
A denial letter is required to state a reason and to reference the criterion applied. That reference is the handle: request the clinical policy document by its identifier and answer it point by point.
Step therapy requires documented trial of preferred alternatives. It is not an argument to be won on merits; it is a record to be produced, and the record is what the appeal must contain.
Careful — the deadline runs from the date on the letter. Waiting for a call back can cost you the appeal entirely.
Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle.
the diagnosis code on the claim is doing more work than anything you write
Kept a log with every date, name of department and reference number. When they claimed no record of a call, I had the reference.