I'm having trouble getting a service approved (prior authorization, step therapy). What can I do?
Carriers must follow specific timelines and provide written denial reasons. The internal appeal process is mandatory before external review. NY has strong external appeal rights through DFS — patients can request external review by an independent reviewer for medical necessity disputes. We help clients navigate prior auth pushback and appeals; for clinically complex cases, the doctor's "peer-to-peer" call with a carrier medical director is often more effective than written appeals.
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- Personal Insurance
- Audience
- For existing clients
- Topic
- Personal Insurance
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