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Insurance appeals

Appealing on cardiovascular indication instead

Started 25 December 2024 · 20 replies · 219 hearts · read 3.6k times

RayBarnsley, UK · 25 December 2024
1.6 years ago

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.

I would like to know whether it is worth appealing, and specifically what changed for the people whose appeals succeeded.

What I cannot find anywhere is the criterion I am being assessed against, and I suspect that is the whole of my problem.

The arithmetic has changed and I need to decide something in the next month, and I would rather decide it with information than in a panic.

Thank you for reading. I know money posts are uncomfortable and I would rather be uncomfortable than stuck.

73

MarthaCork, IE
#1

Mine took four months and three letters and was eventually granted, and I nearly gave up after the first one.

11

FitzLimerick, IE
#2

What I would say is do not accept a phone refusal. Ask for it in writing, always, and the tone often changes when you do.

8

TarnKeswick, UK
#3

The escalation route was buried and existed, and I only found it because somebody in this circle told me what it was called.

13

PetraFacilitatorMelbourne, Australia
#4

Facilitator note: the appeals experience in this circle is a genuine asset. Post your refusal letter and somebody will spot what you have missed.

20me too 2

NkechiAbuja, NG
#5

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.

10

ZebAustin, TX
#6

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.

8

BrimHalifax, UK
#7

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.

14me too 6

MoBradford, UK
#8

Picking up Nkechi’s point rather than starting a new one.

I found that quoting their own document back to them was far more effective than any argument of my own.

6

BodilÅlesund, NO
#9

You have said something a lot of us have not managed to. Thank you.

8me too 7

GroverPortland, ME
#10

Coming back to say mine was granted on the third attempt, sixteen weeks after the first refusal, and the letter that worked was the shortest one.

12

IdaRotterdam, NL
#11

That is a very clear way of putting something I have never been able to put clearly.

7

TiernanOmagh, NI
#12

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

9me too 4

WinkleWeymouth, UK
#13

I kept a log of every call with the date and the name and it was the reason my complaint was taken seriously at the third stage.

10

TheaBergen, NO
#14

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

13

TasnimBradford, UK
#15

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

7

RayBarnsley, UK
#16

Reading Winkle, I recognised more of that than I expected to.

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

10

MarthaCork, IE
#17

Picking up Tasnim’s point rather than starting a new one.

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.

10me too 2

FitzLimerick, IE
#18

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

12

PetraFacilitatorMelbourne, Australia
#19

Speaking as a facilitator: deciding not to appeal is a legitimate decision and this circle has never treated it as giving up. An appeal costs hours and attention that some weeks simply do not have in them.

18

ColNewquay, UK
#20

No wisdom, just: I am sorry. That sounds genuinely hard.

13