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c/insurancefights·submitted 3 months ago by u/coring_the_stopper

[Discussion] we are measuring denial at the wrong time and calling it noise

Discussionbranch of 7 comments

Long-ish post, sorry. tl;dr at the bottom. I have been tracking appeal against ApoB for 27 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,…

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7 comments, started 3 months ago
u/marisol_moreau247 points·3 months ago
reading this at 2am on my 36th week. thank you.
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u/saskia_lokken-32 points·3 months ago

Which state? Coverage varies.

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u/liv_vukovic202 points·3 months ago

copay is separate from coverage

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u/hplc_hobbyistruns their own column65 points·3 months ago·edited

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

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u/tuva_aalto157 points·3 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/karim_restrepo72 points·3 months ago

do not suggest misrepresenting a diagnosis, that is fraud

Yes, exactly this, and it is the bit that took me 89 weeks to accept.

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u/ismael_nwosu119 points·3 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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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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