[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.…
employer plans and individual plans are different fights
Is this a prior authorisation denial or a formulary exclusion?
External review was the thing that finally worked. I did not know it existed until a thread on this board.
prior authorisation criteria change every plan year
prior authorisation criteria change every plan year
Agreed — and request the bulletin by number. They have to give it to you.
prior authorisation criteria change every plan year
canada_coverage is right that this is documentation rather than persuasion. It took me a year to accept that.
That criterion is from the previous plan year. The current bulletin has different wording.