[Discussion] the denial advice in here is 3 years out of date
the denial advice in here is 3 years out of date, and I am aware this is a minority view on this board. 3 years — those are the numbers, and they are the ones I am willing to defend. Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle. Peer-to-peer took fifteen…
ask for the denial reason in writing, always
a template letter that quotes their own criteria back is the strongest one
Prior authorisation criteria are republished each plan year. A criterion that blocked you in one year may not exist in the next, so a denial is worth retesting after the turnover.
Disagree with the tone strategy. Anger has never moved a determination; matching the criterion has.
ask for the denial reason in writing, always
Agreed — and request the bulletin by number. They have to give it to you.
Yes. Written, always, even when they tell you a phone call is sufficient.