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

help me understand appeal, I have read the wiki twice

Questionbranch of 5 comments

Genuinely asking, not being difficult. Everyone in c/labresults repeats that external review is important. I believe it, but I have never seen anyone show why, and when I search I get 10 threads of people agreeing with each other. Is there a paper? Is there a measurement? Or is this one of those things that is true…

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5 comments, started 1 year ago
u/hedda_aguirre19 points·1 year ago

Denied for prior auth, resubmitted with appeal documentation, approved on appeal. The criteria exist, you just have to meet them.

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u/prior_auth_painMOD13 points·1 year ago

Retitled to remove editorialising. Put the evidence in the body.

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u/kasper_cabrera4 points·1 year ago·edited

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

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u/muscle_cramp_moOP7 points·1 year ago

Denied for prior auth, resubmitted with appeal documentation, approved on appeal.

Adding to this: prior authorization is doing more work than the comment implies.

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u/amylin_amyamylin6 points·1 year ago·edited

redact member ids and group numbers from every screenshot

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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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