three years of prior authorization threads, summarised so you do not have to read them
The title is the argument: three years of prior authorization threads, summarised so you do not have to read them. Here is the rest of it. Prior authorisation criteria are republished each plan year. A criterion that blocked you in one year may not exist in the next, so a denial is worth retesting after the turnover.…
That advice is jurisdiction-specific and this board spans several. Say where you are.
Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle.
Correction: that is a formulary exclusion, not a prior authorisation denial. Different form, different route, different deadline.
prior authorisation criteria change every plan year
the second-level appeal is where things actually turn
Small fix — external review is independent of the plan. The second-level internal appeal is not.