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c/insurancefights·posted 2 years ago by u/nnt_nate

Spain: copay, and what it actually costs here

Discussion Slow Clap ×4 Receipts ×3 Clean Column ×2

Spain: copay, and what it actually costs here. Not a hot take, just something I have not seen said plainly here.

External review was the thing that finally worked. I did not know it existed until a thread on this board.

Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle.

Peer-to-peer took fifteen minutes and resolved something a written appeal had been sitting on for a month.

Sceptical readings welcome. The confident ones are the ones I distrust.

8,065 up / 3,030 down73% upvoted55 commentsid fb1o0429 Apr 2024

55 comments

30 in this archive, depth 4

best — the order this archive was captured in

u/marta_vanhecke411 points·2 years ago

Employer-sponsored plans may be regulated differently from individually purchased ones, which changes both the appeal route and which regulator hears a complaint.

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u/nnt_nateOP593 points·2 years ago

That criterion is from the previous plan year. The current bulletin has different wording.

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u/formulary_fighterMOD223 points·2 years ago

Left up. It carries dates, a criterion and an outcome, which is what makes these threads useful.

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u/marisol_moreau273 points·2 years ago

Push back: your plan is an employer plan, which changes both the appeal path and who the regulator is.

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u/nikhil_asante0 points·2 years ago

Push back: your plan is an employer plan, which changes both the appeal path and who the regulator is.

marisol_moreau is right that this is documentation rather than persuasion. It took me a year to accept that.

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u/nnt_nateOP-11 points·2 years ago

marisol_moreau is right that this is documentation rather than persuasion.

This is the whole method. Answer the criterion they named, not the decision in general.

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u/nnt_nateOP1 point·2 years ago

Correction: that is a formulary exclusion, not a prior authorisation denial. Different form, different route, different deadline.

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u/prior_auth_painappeals1 point·2 years ago

Right, and keeping every date and reference number turns a frustrating process into an auditable one.

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u/wholesome_lurker1 point·2 years ago

Not convinced. That is a formulary exclusion rather than a prior authorisation denial, and the route to challenge it is different.

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u/rekha_mbeki1 point·2 years ago·edited

Small fix — external review is independent of the plan. The second-level internal appeal is not.

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u/slow_logbook_notes1 point·2 years ago

I would not skip the peer-to-peer. It is often the fastest route and it costs a phone call.

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u/adaeze_weiss179 points·2 years ago

Kept a log with every date, name of department and reference number. When they claimed no record of a call, I had the reference.

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u/line_petrov103 points·2 years ago

New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January.

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u/vikram_mbeki43 points·2 years ago

This. Step therapy is a paperwork requirement and it is beaten with documentation, not persuasion.

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u/purity_pedantanalytical99 points·2 years ago

The process that has actually worked for people on this board, in order.

Get the denial in writing and find the criterion it names. Request the clinical policy bulletin by its number. Write the appeal against that document, criterion by criterion, attaching what has been tried and for how long. Note the deadline from the letter date and diarise it.

If the first level fails, go to the second. If the second fails, ask about external review, which is independent and, where it applies, binding. Keep every date, department and reference number as you go.

It is administrative rather than rhetorical, and the people who win are the ones who treat it that way.

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u/wholesome_lurker86 points·2 years ago

deadlines run from the letter date, not from when you opened it

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u/rekha_mbeki0 points·2 years ago

What is the appeal deadline on the letter?

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u/honest_syringe1964 points·2 years ago

External review, which is the most underused mechanism discussed on this board.

Internal appeals are decided by the plan. External review sends the determination to an independent body. Where it applies its decision binds the plan, and the deadlines to request it are short and strictly enforced.

The two things that trip people up: not knowing it exists, and exhausting the internal levels so slowly that the external window closes. Ask on the first denial what the external route is and what the deadline will be. Availability and rules vary by jurisdiction and plan type, so say where you are when you ask here.

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u/sock_puppet_spotter51 points·2 years ago

Yes — quoting their own policy bulletin back at them is far more effective than arguing in general terms.

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u/ferran_batista38 points·2 years ago

Asked for the policy bulletin by number and wrote the appeal against its criteria line by line. Approved on the second level after a flat first-level denial.

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[removed]36 points·2 years ago

[removed by moderator]

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u/marta_vanhecke19 points·2 years ago

Yes. Written, always, even when they tell you a phone call is sufficient.

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u/marisol_moreau24 points·2 years ago

Correcting myself upthread: the deadline was 24 days, not the figure I gave.

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u/RetaAndRegret230 points·2 years ago

What exactly does the denial letter give as the reason?

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u/tidy_vialdrawer_watch10 points·2 years ago

a peer-to-peer call is often faster than a written appeal

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u/marta_marchand33 points·2 years ago

Appeal deadlines run from the date on the determination letter. They are strict, they are short, and a missed deadline usually forfeits that level entirely.

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u/ignacio_vanhecke10 points·2 years ago

employer plans and individual plans are different fights

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u/plain_titration_20248 points·2 years ago

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

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u/gustav_vermeulen6 points·2 years ago

ask for the denial reason in writing, always

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About c/insurancefights

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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