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c/insurancefights·submitted 6 months ago by u/elise_grimaldi

[Discussion] external review is doing more work than we give it credit for

Discussionbranch of 8 comments

external review is doing more work than we give it credit for, and I am aware this is a minority view on this board. Kept a log with every date, name of department and reference number. When they claimed no record of a call, I had the reference. Missed a deadline because I counted from when I opened the envelope.…

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8 comments, started 6 months ago
u/jarno_adeyemi89 points·6 months ago

external review exists and almost nobody uses it

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u/hamza_weiss49 points·6 months ago

external review exists and almost nobody uses it

Adding the underused one — external review. Independent, binding where it applies, and hardly anybody gets that far.

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u/canada_coverage39 points·6 months ago

a template letter that quotes their own criteria back is the strongest one

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u/ines_krastev30 points·6 months ago

keep every date, every reference number, every name of a department

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u/elise_grimaldiOP-35 points·6 months ago·edited

What exactly does the denial letter give as the reason?

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u/camila_vasquez25 points·6 months ago

Documented eighteen months of what had been tried in a one-page table. That table was the appeal.

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[removed]28 points·6 months ago

[removed by moderator]

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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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