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  • Prior Auth Denied main episode for 2026-07-21

    Prior Auth Denied main episode for 2026-07-21
    2026/08/25
    In this episode of Prior Auth Denied, we break down exactly what to do when an insurance denial stalls your medication or scan. From decoding the denial letter to requesting policy language and pushing for a peer-to-peer review, Finch outlines practical steps that turn confusion into forward motion. Learn how to mark your 30-day appeal deadline, gather targeted records from your doctor, and structure a clear appeal letter that addresses the insurer’s specific concerns instead of sending a generic request. Discover why keeping meticulous copies and checking for external review options can protect your case through every level.

    Key takeaways:
    - Request the denial letter, clinical criteria, and policy language immediately
    - Confirm peer-to-peer options and track the 30-day appeal window
    - Prepare structured documentation and double-check every attachment
    - Maintain organized records for potential second-level or external reviews

    These targeted actions reduce delays and improve your chances of approval. 📩 Have questions or want to share your experience? Reach out at prior@senseofthisshit.com. Support the show at https://www.spreaker.com/podca...
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    5 分
  • Prior Auth Denied main episode for 2026-07-14

    Prior Auth Denied main episode for 2026-07-14
    2026/08/18
    In this episode of Prior Auth Denied, we break down exactly what to do when that first denial letter lands in your inbox or mailbox. The notice often contains hidden clues like specific denial codes, deadlines, and reasons such as missing notes or unproven necessity. Learn how to read every line carefully, then contact the insurer right away to get the reviewer's name, submission deadlines, and a copy of the internal medical policy that guided the decision. We cover gathering recent progress notes, test results, and proof of conservative treatments from your doctor to build a targeted response. Discover when a peer-to-peer review between your physician and the insurer's medical director can turn things around, plus how to prepare a full written appeal packet if needed. Track every call, reference number, and deadline in one organized folder while exploring time-sensitive alternatives that skip prior auth.

    Key takeaways:
    - Read the denial letter for exact reasons and deadlines before acting
    - Request the internal policy and reviewer details immediately
    - Collect supporting records that directly address the stated denial reason
    - Log all communications to protect your appeal timeline
    - Consider peer-to-peer reviews and external options for stronger cases
    https://www.spreaker.com/podca...

    📩 Have questions or want to share your experience? Reach out at prior@senseofthisshit.com.
    💛 Join Our Supporters Club ($3 a month) 💛 Ad-free listening + early episodes — help keep independent media alive. Click Here: https://www.spreaker.com/podca...
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    4 分
  • Navigate Prior Authorization Denials: Appeals Playbook & Peer-to-Peer Calls

    Navigate Prior Authorization Denials: Appeals Playbook & Peer-to-Peer Calls
    2026/07/11
    In this episode of Prior Auth Denied, we deliver a plain-English playbook for tackling prior authorization blocks, claim denials, and appeals. Learn exactly what to ask insurance reps, which documents to send, and when a peer-to-peer review can speed things up—without the usual runaround. From decoding your denial notice to tracking deadlines and prepping your doctor, these targeted steps help cut through delays and improve your odds of approval.

    Key takeaways include:
    - Read the denial notice word-for-word and request the plan’s internal policy during your call.
    - Gather matching clinical notes from your doctor’s office within two business days.
    - Request a peer-to-peer conversation if the first appeal stalls, and arm your physician with a one-page symptom summary.
    - File a concise formal appeal letter citing the exact policy language, while marking the 60- or 180-day deadline.

    📩 Have questions or want to share your experience? Reach out at prior@senseofthisshit.com.
    💛 Join Our Supporters Club ($3 a month) 💛 Ad-free listening + early episodes — help keep independent media alive. Click Here: https://www.spreaker.com/podca...
    続きを読む 一部表示
    5 分