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c/insurancefights·submitted 11 months ago by u/wholesome_lurker

copay — 3 things I got wrong before I got it right

Discussionbranch of 6 comments

I have had 8 orders now and I keep a table, so here is the honest summary rather than a vibe. Material has been consistent. Communication has not. Shipping has varied by about 24 days on nominally the same lane, which matters more in summer than in February. The independent number came back 98.4% against a claimed…

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6 comments, started 10 months ago
u/liv_vukovic70 points·10 months ago

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

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u/plain_titration17 points·10 months ago

Strongly agree.

Disagree on that part. 95.1% and 98.7% on the same vial is normal.

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u/hugo_pires5 points·10 months ago

appeal letter templates are in the wiki

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u/teodor_duarte6 points·10 months ago

Strongly agree.

Adding to this: formulary is doing more work than the comment implies.

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u/hassan_chowdhury36 points·10 months ago

prior auth criteria are state-specific, step therapy differs

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u/neha_rahimi-35 points·10 months ago

redact member ids and group numbers from every screenshot

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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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