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Single comment threadYou are looking at one branch of three years of denial threads, summarised so you do not have to read them — 43 comments in the full submission. View in context.
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c/insurancefights·submitted 7 months ago by u/valeria_grimaldi

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

Discussionbranch of 6 comments

three years of denial threads, summarised so you do not have to read them. It is the sort of thing everyone half-believes and nobody writes down. 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. Spent six…

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6 comments, started 7 months ago
u/marta_dziedzic107 points·7 months ago

Same view. The second-level appeal is where mine turned, after a first-level denial that looked final.

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u/edit_for_clarity55 points·7 months ago

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_dziedzic35 points·7 months ago

I would not skip the peer-to-peer. It is often the fastest route and it costs a phone call.

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u/adaeze_weiss29 points·7 months ago·edited

That criterion is from the previous plan year. The current bulletin has different wording.

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u/marisol_moreau12 points·7 months ago

External review was the thing that finally worked. I did not know it existed until a thread on this board.

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u/gustav_vermeulen36 points·7 months ago

deadlines run from the letter date, not from when you opened it

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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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