[Discussion] can we stop arguing about appeal until somebody posts a number
can we stop arguing about appeal until somebody posts a number — that is what I am asking, and I have already read the wiki twice. External review, which is the most underused mechanism discussed on this board. Internal appeals are decided by the plan. External review sends the determination to an independent body.…
A peer-to-peer conversation puts the prescribing clinician in front of a reviewing clinician. It bypasses the correspondence cycle entirely and is often the fastest available route.
New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January.
What is the appeal deadline on the letter?
Left up. It carries dates, a criterion and an outcome, which is what makes these threads useful.
What has been documented as tried, and for how long?
a peer-to-peer call is often faster than a written appeal