Insurance appeals · call recap
Four paragraphs a reviewer can act on
19 May 202511 attendedHeld by Petra
A writing workshop, which is what most of this circle actually is. Eleven people with a refusal identified and a criterion in hand, spending an hour on the four paragraphs. The rule I hold: a reviewer has a few minutes and a checklist, and your job is to make it possible for them to say yes without doing any work.
The four paragraphs
One: who you are, the policy or plan reference, the decision and its date. No feeling. Two: the criterion, quoted from their own document. Three: the evidence that answers that criterion, itemised, with the enclosure named against each item. Four: what you are asking for, in one sentence.
That is it. It is short, it is dull, and it is the version that gets acted on. The thing people most want to write — the paragraph about how much this matters and how hard the year has been — is the paragraph that most reliably makes the letter longer and weaker.
What came up
The hardest part is paragraph three, because it usually requires something from a clinician and asking for that is where people stall. Zeb's had turned on two sentences from his physician that he had had to go back and specifically request. Nadia described asking a busy doctor for a letter and being told to come back in a month, and how she got it in a week instead: she wrote the sentences she needed, sent them, and asked whether he would be willing to say that in his own words if he agreed with it.
Three people are now doing that. It is the single most effective thing anybody has brought to this circle.
Where we left it
With eleven drafts and a promise to read any of them. Also with an honest note: two members in this room have been refused twice and are heading to an external review, and I told them plainly that external review is slower, more formal, and worth doing, and that it may still go against them.