[Discussion] the copay advice in here is 2 years out of date
the copay advice in here is 2 years out of date. Change my mind, genuinely — I have no stake in being right about this. The numbers the title promised, since a headline without them is worthless: 2 years. Everything below is context for those. Appeal deadlines run from the date on the determination letter. They are…
A denial letter is required to state a reason and to reference the criterion applied. That reference is the handle: request the clinical policy document by its identifier and answer it point by point.
Agreed on the plan-year point. Criteria that applied last year may simply not apply now.
Agreed on the plan-year point.
Disagreeing with this line: the deadline runs from the letter date and treating it otherwise is expensive.
Peer-to-peer took fifteen minutes and resolved something a written appeal had been sitting on for a month.
Documented eighteen months of what had been tried in a one-page table. That table was the appeal.
That criterion is from the previous plan year. The current bulletin has different wording.
Correcting myself upthread: the deadline was 10 days, not the figure I gave.
the denial letter names the criterion, start there
Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle.
Missed a deadline because I counted from when I opened the envelope.
elin_varga is right that this is documentation rather than persuasion. It took me a year to accept that.