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

[Meta] the appeal rule is doing its job and people should stop complaining

Appealbranch of 6 comments

Right, the denial question again, but with numbers this time. I have 5 data points over 16 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign. The thing I would flag for anyone new: the effect I am describing…

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6 comments, started 2 years ago
u/cato_achebe39 points·2 years ago·edited

This is correct. Appeal letters work.

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u/honest_syringe1910 points·2 years ago

say which country and which plan type

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u/osman_ferrari12 points·2 years ago

say which country and which plan type

Disagree on that part. 93.7% and 99.3% on the same vial is normal.

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u/saskia_rahimi8 points·2 years ago

Slight fix: the number was 99.0, not 98.9. Decimal point, but a fairly consequential one.

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u/sofia_nascimento2 points·2 years ago

What was the denial code?

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u/tidy_vialdrawer_watch12 points·2 years ago

copay is separate from coverage

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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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