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c/insurancefights·submitted 2 years ago by u/nnt_nate

Spain: copay, and what it actually costs here

Discussionbranch of 8 comments

Spain: copay, and what it actually costs here. Not a hot take, just something I have not seen said plainly here. External review was the thing that finally worked. I did not know it existed until a thread on this board. Missed a deadline because I counted from when I opened the envelope. That mistake cost me an…

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8 comments, started 2 years ago
u/marisol_moreau273 points·2 years ago

Push back: your plan is an employer plan, which changes both the appeal path and who the regulator is.

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u/nikhil_asante0 points·2 years ago

Push back: your plan is an employer plan, which changes both the appeal path and who the regulator is.

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

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u/nnt_nateOP-11 points·2 years ago

marisol_moreau is right that this is documentation rather than persuasion.

This is the whole method. Answer the criterion they named, not the decision in general.

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u/nnt_nateOP1 point·2 years ago

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

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u/prior_auth_painappeals1 point·2 years ago

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

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u/wholesome_lurker1 point·2 years ago

Not convinced. That is a formulary exclusion rather than a prior authorisation denial, and the route to challenge it is different.

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u/rekha_mbeki1 point·2 years ago·edited

Small fix — external review is independent of the plan. The second-level internal appeal is not.

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u/slow_logbook_notes1 point·2 years 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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About c/insurancefights

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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