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c/insurancefights·submitted 2 months ago by u/cardio_endpoint_c

prior authorization — 22 things I got wrong before I got it right

Deniedbranch of 7 comments

prior authorization — 22 things I got wrong before I got it right, and I am aware this is a minority view on this board. Kept a log with every date, name of department and reference number. When they claimed no record of a call, I had the reference. Documented eighteen months of what had been tried in a one-page…

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7 comments, started 2 months ago
u/peak_area_peteanalytical38 points·2 months ago

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

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u/rekha_vestergaard20 points·2 months ago

Disagree with the tone strategy. Anger has never moved a determination; matching the criterion has.

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u/cardio_endpoint_cOP16 points·2 months ago

Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting their own criteria turned it around in eleven days.

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u/cardio_endpoint_cOP7 points·2 months ago

Has a peer-to-peer been offered or requested?

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u/ilias_cabrera20 points·2 months ago

What exactly does the denial letter give as the reason?

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u/cardio_endpoint_cOP14 points·2 months ago

What exactly does the denial letter give as the reason?

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

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u/ferran_batista6 points·2 months ago

appeal in writing even when they say a call is enough

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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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