{"id":"life-hc-prior-auth-denial","audience":"healthcare","category":"everyday-life","track":"life","technique":"grounding","title":"Understand an insurance denial letter and the next step","free":false,"task":"Your insurer denied coverage for a test your doctor ordered for you. Get exactly 4 numbered lines in plain text: 1. what was denied and why, in plain words; 2. the appeal deadline as a date with the math shown; 3. what the letter says your doctor can do; 4. one question for your doctor's office, starting \"Ask:\". End with \"This isn't legal or medical advice.\" Keep it under 140 words. Write a prompt that gets you exactly that.","materialLabel":"The denial letter (attached to your prompt automatically)","material":"NORTHSTAR HEALTH PLAN - NOTICE OF ADVERSE BENEFIT DETERMINATION (fictional)\nMember: Priya Desai | Member ID: NHP-220917\nDate of notice: October 31, 2026\nRequested service: Sleep study (in-lab polysomnography)\nOrdering provider: Dr. R. Bannister\n\nDECISION: Denied - prior authorization not approved.\n\nREASON: Our medical policy MP-114 requires a home sleep test before an in-lab study is covered, unless the provider documents a reason a home test is not appropriate. We did not receive records of a home sleep test or such a reason.\n\nYOUR RIGHTS\n- You or your provider may request an internal appeal within 60 days of the date of this notice.\n- Your provider may request a peer-to-peer review with our medical director within 14 days of this notice by calling 1-800-555-0166.\n- Your provider may also submit a new request for a home sleep test, which does not require prior authorization.\n\nQuestions: Member Services, 1-800-555-0187.\n\nMy notes:\n- Dr. Bannister's office said they \"sent everything.\"\n- Coworker says insurers deny everything the first time and you should just get a lawyer.\n- I've never had a home sleep test.","rules":[{"type":"numberedItems","count":4},{"type":"maxWords","max":140},{"type":"plainText"}],"mistakes":[{"title":"Not asking for the date","why":"The AI says \"60 days\" without turning it into a date you can put on a calendar.","fix":"Add: \"Line 2: Oct 31 + 60 days = [date].\"","checks":["r0"]},{"title":"Missing the doctor's options","why":"The AI focuses on appeals and skips the faster steps the letter lists for your doctor.","fix":"Add: \"Line 3: what the letter says my doctor can do, with deadlines.\"","checks":["r1"]},{"title":"Picking up the coworker's advice","why":"The AI suggests a lawyer or judges whether the test is needed.","fix":"Add: \"No legal or medical opinions. End with: This isn't legal or medical advice.\"","checks":["r2"]},{"title":"Getting a long explainer","why":"The AI writes sections on your rights with headings and bullets.","fix":"Say: \"Exactly 4 numbered lines, one sentence each. Plain text.\"","checks":["numberedItems","plainText"]},{"title":"Trusting the AI to count words","why":"AI is bad at counting. Ask for \"under 140 words\" and it often lands well over.","fix":"Cap each part: \"each line under 22 words.\"","checks":["maxWords"]}],"promptHints":[{"label":"Asks for the date math","patterns":["\\+\\s*60","60 days","date"]},{"label":"Asks what the doctor can do","patterns":["doctor can","peer.to.peer","provider"]},{"label":"Adds the disclaimer","patterns":["(legal|medical) advice","disclaimer"]},{"label":"Sets the number of lines","patterns":["\\b(4|four)\\b.{0,20}(lines?|numbered|items?|steps?)"]},{"label":"Sets a word limit","patterns":["\\d+\\s*words","word (limit|count)"]}],"hint":"A denial letter has a reason, a deadline and options. Tell the AI to turn the deadline into a date, pull your doctor's options, and keep opinions out.","rubricLabels":["Line 1 says the in-lab sleep study was denied because the plan requires a home sleep test first (or a documented reason one isn't appropriate), and line 2 gives the appeal deadline as December 30, 2026 (October 31 + 60 days)","Line 3 names what the doctor can do from the letter (peer-to-peer review within 14 days, by Nov 14, and/or a new request for a home sleep test), and line 4 starts with \"Ask:\"","Ends with \"This isn't legal or medical advice.\" and doesn't suggest a lawyer or say whether she needs the test"]}