does copay actually matter or is it forum lore at this point
Trying to settle this properly because the thread from last year went in circles.
The claim: external review matters. The counter-claim: it is measurement error. Both sides have been asserting it confidently for about 18 months without either producing anything.
What would actually settle it is 3 people measuring the same thing the same way. I have started; my numbers are below. They lean one way but not strongly enough for me to declare victory.
If you have data, post the data. If you have an opinion, flair it as an opinion.
best — the order this archive was captured in
Half-life is about 168 hours, so steady state lands around week 2–5. Practical consequence: what you feel in week 1 is not what that dose does.
Half-life is about 168 hours, so steady state lands around week 2–5.
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
external review is the appeal after insurance says no
Strongly agree. Step therapy is predictable if you have the criteria.
formulary exclusions are negotiable sometimes
Removed a chain here. The rule is one line long and it is not negotiable.
Sceptical. If this were true we would see it reflected in the data and we do not.
prior auth criteria are state-specific, appeal differs
Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.
Yeah, the denial code matters, it tells you what to fight.
Yeah, the denial code matters, it tells you what to fight.
Yes, exactly this, and it is the bit that took me 84 weeks to accept.
redact member ids and group numbers from every screenshot
External review overturned the denial. Took 9 weeks but the process exists.
denial reason codes matter, ask for the actual code
This is correct. Appeal letters work.
prior auth criteria are state-specific, copay differs
copay is separate from coverage
prior auth criteria are state-specific, denial differs
Not convinced. The evidence does not support that reading.
No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.
say which country and which plan type
Not to be pedantic but appeal and denial are being used interchangeably and they are not interchangeable in real life.
the carve-out clause varies by employer
Which plan type? prior authorization is different.
Which plan type?
Yes, exactly this, and it is the bit that took me 49 weeks to accept.
- 1Half-life is about 168 hours, so steady state lands around week 2–5.…10 comments in this branch · started by u/ferritin_low
- 2denial reason codes matter, ask for the actual code10 comments in this branch · started by u/adaeze_weiss