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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 5 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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5 comments, started 10 months ago
u/arne_amankwah19 points·10 months ago

This is correct. Appeal letters work.

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u/wholesome_lurkerOP14 points·10 months ago

Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.

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u/milos_vestergaard10 points·10 months ago

Not convinced. The evidence does not support that reading.

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u/prior_auth_painappeals10 points·10 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/cardio_endpoint_c3 points·10 months ago·edited

do not suggest misrepresenting a diagnosis, that is fraud

Yes, exactly this, and it is the bit that took me 24 weeks to accept.

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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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