[Template] my appeal letter, take it, it is free
Long-ish post, sorry. tl;dr at the bottom.
I have been tracking prior authorization against A1c for 39 weeks because I could not find anyone who had. The correlation is weaker than I expected, which is itself mildly interesting given how confidently people link the two in here.
Caveats up front: one person, one lab, one assay, no control, and I changed my training in the middle of it, which was stupid.
tl;dr: probably real, definitely smaller than the threads imply, and not worth reorganising your week around.
best — the order this archive was captured in
Sweden plan: step therapy required 8 medications first. Did them all, got approval. The order matters.
appeal letter templates are in the wiki
Small correction: the trial was 7 weeks, not 9. Does not change your point but people will quote it.
Not to be pedantic but formulary and step therapy are being used interchangeably and they are not interchangeable in real life.
Yeah, the denial code matters, it tells you what to fight.
denial reason codes matter, ask for the actual code
You have restated the marketing copy. What is the actual substance here.
formulary exclusions are negotiable sometimes
Strongly agree. Step therapy is predictable if you have the criteria.
redact member ids and group numbers from every screenshot
prior auth criteria are state-specific, copay differs
You have restated the marketing copy.
Disagree on that part. 98.1% and 98.3% on the same vial is normal.
- 1Sweden plan: step therapy required 8 medications first. Did them all, got…8 comments in this branch · started by u/pavel_nkemelu
- 2You have restated the marketing copy. What is the actual substance here.6 comments in this branch · started by u/neha_erdogan