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c/insurancefights·posted 9 months ago by u/neha_rahimi

why does nobody talk about denial

Appeal Clean Column ×2 Cold Box ×1 Slow Clap ×1

Question in the title, detail here: why does nobody talk about denial.

New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January.

The process that has actually worked for people on this board, in order.

Get the denial in writing and find the criterion it names. Request the clinical policy bulletin by its number. Write the appeal against that document, criterion by criterion, attaching what has been tried and for how long. Note the deadline from the letter date and diarise it.

If the first level fails, go to the second. If the second fails, ask about external review, which is independent and, where it applies, binding. Keep every date, department and reference number as you go.

It is administrative rather than rhetorical, and the people who win are the ones who treat it that way.

Documented eighteen months of what had been tried in a one-page table. That table was the appeal.

If somebody has the same thing measured a different way, post it next to mine and we will see whether they agree.

2,935 up / 265 down92% upvoted36 commentsid ezvt3x18 Oct 2025

36 comments

20 in this archive, depth 5

best — the order this archive was captured in

u/tomas_lehtinen155 points·9 months ago

Prior authorisation criteria are republished each plan year. A criterion that blocked you in one year may not exist in the next, so a denial is worth retesting after the turnover.

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u/hplc_hobbyistruns their own column52 points·9 months ago

prior authorisation criteria change every plan year

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u/sofia_ferreira39 points·9 months ago

prior authorisation criteria change every plan year

hplc_hobbyist is right that this is documentation rather than persuasion. It took me a year to accept that.

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u/vito_beaulieu32 points·9 months ago

Correction: that is a formulary exclusion, not a prior authorisation denial. Different form, different route, different deadline.

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u/tuva_aalto-30 points·9 months ago

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.

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u/elin_lindqvist1 point·9 months ago

Employer-sponsored plans may be regulated differently from individually purchased ones, which changes both the appeal route and which regulator hears a complaint.

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[removed]1 point·9 months ago

[removed by moderator]

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u/rekha_vestergaard64 points·9 months ago·edited

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/formulary_fighterMOD103 points·9 months ago

Left up. It carries dates, a criterion and an outcome, which is what makes these threads useful.

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u/nadia_trevino73 points·9 months ago

Step therapy requires documented trial of preferred alternatives. It is not an argument to be won on merits; it is a record to be produced, and the record is what the appeal must contain.

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u/milan_wikstrom92 points·9 months ago

Right, and keeping every date and reference number turns a frustrating process into an auditable one.

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u/plain_titration_202431 points·9 months ago

That advice is jurisdiction-specific and this board spans several. Say where you are.

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u/oskar_kaufmann108 points·9 months ago

a template letter that quotes their own criteria back is the strongest one

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u/ferran_dahlberg53 points·9 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/tidy_vialdrawer_watch17 points·9 months ago

external review exists and almost nobody uses it

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u/tuva_aalto4 points·9 months ago

Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle.

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u/amara_haddad44 points·9 months ago

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

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u/vito_beaulieu25 points·9 months ago

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.

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u/plain_titration_202412 points·9 months ago

This. Step therapy is a paperwork requirement and it is beaten with documentation, not persuasion.

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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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