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c/insurancefights·submitted 3 days ago by u/marisol_moreau

[Template] my appeal letter, take it, it is free

Templatebranch of 6 comments

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,…

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6 comments, started 2 days ago
u/neha_erdogan6 points·2 days ago

You have restated the marketing copy. What is the actual substance here.

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u/emeka_delgado-4 points·2 days ago

formulary exclusions are negotiable sometimes

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u/RetaAndRegret21 point·2 days ago·edited

Strongly agree. Step therapy is predictable if you have the criteria.

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u/saskia_lokken1 point·2 days ago

redact member ids and group numbers from every screenshot

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u/coring_the_stopper1 point·1 days ago·edited

prior auth criteria are state-specific, copay differs

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u/tomas_lehtinen4 points·2 days ago

You have restated the marketing copy.

Disagree on that part. 98.1% and 98.3% on the same vial is normal.

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The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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