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c/insurancefights·submitted 2 years ago by u/elin_varga

[Discussion] the copay advice in here is 2 years out of date

Discussionbranch of 6 comments

the copay advice in here is 2 years out of date. Change my mind, genuinely — I have no stake in being right about this. The numbers the title promised, since a headline without them is worthless: 2 years. Everything below is context for those. Appeal deadlines run from the date on the determination letter. They are…

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6 comments, started 2 years ago
u/appeal_letter_alMOD150 points·2 years ago

Member and policy numbers redacted from the screenshot above. Everything else left as posted.

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u/sofia_ferreira63 points·2 years ago

Disagree with the tone strategy. Anger has never moved a determination; matching the criterion has.

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u/janoshik_junkieindependent tester41 points·2 years ago

That advice is jurisdiction-specific and this board spans several. Say where you are.

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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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