how much of what we believe about copay actually comes from appeal threads
how much of what we believe about copay actually comes from appeal threads. Searched first, found three threads that contradict each other, hence the post. Asked for the policy bulletin by number and wrote the appeal against its criteria line by line. Approved on the second level after a flat first-level denial.…
Appeal deadlines run from the date on the determination letter. They are strict, they are short, and a missed deadline usually forfeits that level entirely.
ask for the denial reason in writing, always
Correction: that is a formulary exclusion, not a prior authorisation denial. Different form, different route, different deadline.
deadlines run from the letter date, not from when you opened it
document what has been tried and for how long, that is the whole case
That advice is jurisdiction-specific and this board spans several. Say where you are.
Which country and which plan year are we talking about?