three years of appeal threads, summarised so you do not have to read them
three years of appeal threads, summarised so you do not have to read them. I have gone back and forth on this for months. Kept a log with every date, name of department and reference number. When they claimed no record of a call, I had the reference. Prior authorisation criteria are republished each plan year. A…
appeal in writing even when they say a call is enough
Small fix — external review is independent of the plan. The second-level internal appeal is not.
I would not skip the peer-to-peer. It is often the fastest route and it costs a phone call.
Small fix — external review is independent of the plan.
Agreed — and request the bulletin by number. They have to give it to you.
a peer-to-peer call is often faster than a written appeal
Not convinced. That is a formulary exclusion rather than a prior authorisation denial, and the route to challenge it is different.
Documented eighteen months of what had been tried in a one-page table. That table was the appeal.
ask for the denial reason in writing, always
a peer-to-peer call is often faster than a written appeal
Disagreeing with this line: the deadline runs from the letter date and treating it otherwise is expensive.
That criterion is from the previous plan year. The current bulletin has different wording.