Money and access
Insurance appeals
A refusal letter is a first draft, not a verdict.
Most people lose to an administrative process because nobody told them there was a process. This circle is unromantic and extremely practical: what the refusal actually said versus what it appeared to say, which criterion you are being measured against, what evidence answers that criterion, and how to write four paragraphs a reviewer can act on.
We keep a running count of appeals members have won. It is one of the better pages on this site.
Who this circle is for
- You have had a refusal and do not know where to start
- You are preparing an appeal or an external review
- You have won one and can describe exactly how
Agreements here
- We help with process and wording, never with misrepresenting anything
- No naming individual staff at any insurer or practice
Employer plan exclusions and how I read mine
Mo14 replies
A question rather than an update: Employer plan exclusions and how I read mine Money post. No apologies, this circle is for it. I have written down what has actually happened, in order,…
External review — how it works and what it needed
Brim17 replies
Starting a thread on this because it keeps coming up in ones and twos: External review — how it works and what it needed This is the boring administrative kind of problem, which I gather…
Refused again, and where I went next
Grover16 replies
Starting a thread on this because it keeps coming up in ones and twos: Refused again, and where I went next I have a letter in front of me and I do not know what it actually says. I have…
My prior authorisation checklist
Fitz17 replies
My prior authorisation checklist — putting it in its own thread so it does not get lost in the check-in. Money post. No apologies, this circle is for it. I have written down what has…
What my HR benefits team could actually do
Col13 replies
Something I have been sitting with: What my HR benefits team could actually do Not looking for advice so much as other people's experience. I have a letter in front of me and I do not know…
Denied for the wrong diagnosis code
Mo17 replies
Denied for the wrong diagnosis code — putting it in its own thread so it does not get lost in the check-in. This is the boring administrative kind of problem, which I gather is the kind…
Second-level appeal, granted, eleven weeks
Tarn21 replies
Starting a thread on this because it keeps coming up in ones and twos: Second-level appeal, granted, eleven weeks This is the boring administrative kind of problem, which I gather is the…
A win after two years of trying
Tarn18 replies
A win after two years of trying — putting it in its own thread so it does not get lost in the check-in. I have a letter in front of me and I do not know what it actually says. What I keep…
Getting my clinician to write the letter that mattered
Ida19 replies
Something I have been sitting with: Getting my clinician to write the letter that mattered Not looking for advice so much as other people's experience. This is the boring administrative…
A flowchart I made for my own appeal, shared
Ray24 replies
A question rather than an update: A flowchart I made for my own appeal, shared This is the boring administrative kind of problem, which I gather is the kind that actually gets solved. I…
The refusal letter was a template and I answered it like one
Brim20 replies
The refusal letter was a template and I answered it like one Writing it down partly to work out what I actually think. This is the boring administrative kind of problem, which I gather is…
The four paragraphs that worked
Tarn21 replies
The four paragraphs that worked — putting it in its own thread so it does not get lost in the check-in. Money post. No apologies, this circle is for it. The thing that has surprised me…
Appealing on cardiovascular indication instead
Ray20 replies
Appealing on cardiovascular indication instead — putting it in its own thread so it does not get lost in the check-in. Money post. No apologies, this circle is for it. What I keep tripping…
Which criterion was I actually being measured against
Zeb24 replies
Which criterion was I actually being measured against Writing it down partly to work out what I actually think. I have a letter in front of me and I do not know what it actually says. I…