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c/insurancefights·submitted 10 months ago by u/prior_auth_pain

three years of copay threads, summarised so you do not have to read them

Discussionbranch of 6 comments

three years of copay threads, summarised so you do not have to read them. I have gone back and forth on this for months. Internal appeals are decided by the plan. External review is decided by an independent body and, where it applies, its determination is binding. They are separate mechanisms and the second is…

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6 comments, started 10 months ago
u/sanne_novak54 points·10 months ago·edited

Careful — the deadline runs from the date on the letter. Waiting for a call back can cost you the appeal entirely.

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u/marta_vanhecke18 points·10 months ago

Which country and which plan year are we talking about?

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u/hugo_pires9 points·10 months ago

appeal in writing even when they say a call is enough

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u/prior_auth_painOPappeals5 points·10 months ago

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

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u/solene_eriksen-1 point·10 months ago

Cosigning on external review. It is a real mechanism, it is underused, and the deadlines are strict.

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u/hassan_castellanos1 point·10 months ago

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

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