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c/insurancefights·submitted 1 year ago by u/hassan_chowdhury

prior authorization — 9 things I got wrong before I got it right

Appealbranch of 4 comments

Quick one. Canada here. prior authorization works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US. Specifics: the route I used took 9 weeks and cost roughly what I expected. The admin was worse…

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4 comments, started 1 year ago
u/pavel_nkemelu177 points·1 year ago
this deserves more than 20 upvotes
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u/prior_auth_painappeals111 points·1 year ago

Disagree. What you are describing is consistent with formulary, not with what you concluded.

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u/pavel_nkemelu52 points·1 year ago·edited

Yeah, the denial code matters, it tells you what to fight.

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u/nikhil_asante57 points·1 year ago

resubmission after denial requires new documentation

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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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