Got the denial in July. The appeal looked terminal, so I asked my clinician to hold and resubmit after the October 1 formulary update.
Pharmacy just ran it and the claim paid. Same plan, same chart notes, only the coverage criteria changed.
I track auth dates and denial codes in a spreadsheet; this one went from non-formulary to approved in about 36 hours. I'm not reading anything into it beyond timing, but it's a reminder that old denial letters can go stale.
Anyone else get a clean reversal after a formulary update?
👍 1