Denied for the wrong diagnosis code

Something that helped was a template somebody here shared, which I rewrote in my own words and which gave me the structure I was missing.

My employer's HR had a route I did not know existed and it went through in eleven days after four months of getting nowhere myself.

The thing nobody tells you is that a refusal is often about missing information rather than a judgement, and supplying it is the whole job.

The deadline for appealing is often short and buried. Mine was twenty-eight days and I found that out on day twenty-three.

Something I would flag: ask whether there is an independent review stage, because there usually is and it is rarely advertised.

What I got wrong was appealing emotionally. The letter that worked was boring, numbered and entirely factual.

What I learned is that the person reading it is following a policy document, and the policy document is usually available if you ask for it.

What surprised me was how routine this is at their end. My refusal was not personal and treating it as procedural made it much easier to fight.

Here, reading, and glad you posted.

My prescriber's practice had done dozens of these and their administrator knew exactly what to write. Ask whether yours has somebody like that.

I would say get everything you have already been told in writing before you start, because verbal assurances evaporate.

Something practical: I sent everything recorded delivery and referenced the previous letter by date in every new one.

Agreed, and I have nothing to add to it.