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c/insurancefights·submitted 2 months ago by u/cardio_endpoint_c

anyone else notice prior authorization kicking in around week 69

Deniedbranch of 5 comments

I have had 16 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 30 days on nominally the same lane, which matters more in summer than in February. The independent number came back 93.7% against a claimed…

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5 comments, started 2 months ago
u/ilias_cabrera208 points·2 months ago

say which country and which plan type

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u/whois_wanda165 points·2 months ago

The confident tone is doing a lot of work that the evidence is not.

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u/cardio_endpoint_cOP99 points·2 months ago

Australia plan: step therapy required 10 medications first. Did them all, got approval. The order matters.

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u/jarno_adeyemi59 points·2 months ago

Mechanistically the bit that matters is formulary. It explains most of the early profile and a decent chunk of the outcome.

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u/tuva_aalto47 points·2 months ago·edited

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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