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

denial: the version I wish someone had shown me in week 1

Appealbranch of 5 comments

Quick one. Canada here. prior authorization works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US. Specifics: the route I used took 17 weeks and cost roughly what I expected. The admin was worse…

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5 comments, started 2 years ago
u/osman_ferrari39 points·2 years ago

the carve-out clause varies by employer

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u/idris_iyer26 points·2 years ago

This is correct. Appeal letters work.

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u/osman_ferrari19 points·2 years ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/milos_vestergaardOP7 points·2 years ago

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

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u/saskia_rahimi8 points·2 years ago·edited

external review is the appeal after insurance says no

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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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