[Meta] proposal — a flair for appeal posts
proposal — a flair for appeal posts. This affects how posts get sorted and removed, so it belongs in the open. 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. Employer-sponsored plans may be regulated…
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.
external review exists and almost nobody uses it
Small fix — external review is independent of the plan. The second-level internal appeal is not.
What exactly does the denial letter give as the reason?
a peer-to-peer call is often faster than a written appeal
employer plans and individual plans are different fights
appeal in writing even when they say a call is enough
step therapy is a documentation problem, not an argument