Wiki No Authorization Appeal

[vtitus]

We received some denials for no auth for chemotherapy. When we verified benefits we were told no auth was needed. Does anyone have an appeal letter template for this particular issue?

 

[csperoni]

I do not have a template, but usually send a letter giving the date/time/representative/reference # of when we were told no auth needed. I explain that we cannot possibly have complied with their requirement for authorization when their own representative provided incorrect information when we tried to obtain auth. We took all the required steps and insurance company made the error. Close with "It is unreasonable to financially penalize the provider for your representative's inaccurate information. I am certain when you review the above referenced call, you will agree this claim should be paid."