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c/insurancefights·submitted 1 year ago by u/fabio_kuipers

does copay actually matter or is it forum lore at this point

Questionbranch of 10 comments

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…

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10 comments, started 1 year ago
u/adaeze_weiss122 points·1 year ago

denial reason codes matter, ask for the actual code

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u/janoshik_junkieindependent tester166 points·1 year ago

This is correct. Appeal letters work.

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u/hugo_pires0 points·1 year ago

prior auth criteria are state-specific, copay differs

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u/elin_lindqvist80 points·1 year ago

copay is separate from coverage

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u/dose_diary_danalog keeper61 points·1 year ago

prior auth criteria are state-specific, denial differs

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u/line_bergstrom50 points·1 year ago·edited

Not convinced. The evidence does not support that reading.

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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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