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Single comment threadYou are looking at one branch of genuine question about denial that I am slightly embarrassed to ask — 66 comments in the full submission. View in context.
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c/insurancefights·submitted 1 year ago by u/saskia_lokken

genuine question about denial that I am slightly embarrassed to ask

Appealbranch of 11 comments

Confession thread, sort of. I went from 0.5mg to 12.5mg much faster than I should have because the scale had stalled and I got impatient. The stall broke about 5 weeks later, at which point I had no way of knowing whether the dose increase did anything or whether it would have broken anyway. So now I have sulphur…

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This branch

11 comments, started 1 year ago
u/plain_titration37 points·1 year ago

Sceptical. If this were true we would see it reflected in the data and we do not.

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u/saskia_lokkenOP15 points·1 year ago

Which plan type? appeal is different.

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u/janoshik_junkieindependent tester6 points·12 months ago

Which state? Coverage varies.

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u/hamza_weiss6 points·12 months ago

redact member ids and group numbers from every screenshot

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u/formulary_fighterMOD19 points·1 year ago

This is an urgent-care question wearing a forum question's clothes. Please contact a clinician rather than waiting for replies.

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u/saskia_lokkenOP12 points·1 year ago

External review overturned the denial. Took 5 weeks but the process exists.

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[removed]14 points·1 year ago

[removed by moderator]

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u/valeria_grimaldi23 points·1 year ago

This is the "correlation is mechanism" thing again. You changed three variables at once.

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u/tomas_lehtinen19 points·12 months ago·edited

external review is the appeal after insurance says no

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u/emeka_delgado12 points·1 year ago

denial reason codes matter, ask for the actual code

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u/milan_wikstrom11 points·1 year ago

Yeah, the denial code matters, it tells you what to fight.

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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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