week 21 check-in — 37kg down, early fullness manageable, one thing confusing me
Quick one. Canada here.
formulary works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US.
Specifics: the route I used took 22 weeks and cost roughly what I expected. The admin was worse than the cost. The thing that would have saved me the most time was knowing which document to ask for at the start.
Happy to answer questions from anyone in the same jurisdiction.
best — the order this archive was captured in
External review overturned the denial. Took 20 weeks but the process exists.
resubmission after denial requires new documentation
This is an urgent-care question wearing a forum question's clothes. Please contact a clinician rather than waiting for replies.
denial reason codes matter, ask for the actual code
Disagree but this is the good kind of wrong — it is specific enough to be checked.
resubmission after denial requires new documentation
do not suggest misrepresenting a diagnosis, that is fraud
Small correction: the trial was 23 weeks, not 36. Does not change your point but people will quote it.
Which plan type? prior authorization is different.
redact member ids and group numbers from every screenshot
This is correct. Appeal letters work.
Every time this gets posted it hits the front page and every time someone has to re-explain it.
Yeah, the denial code matters, it tells you what to fight.
Mechanistically the bit that matters is prior authorization. It explains most of the early profile and a decent chunk of the outcome.
Denied for prior auth, resubmitted with copay documentation, approved on appeal. The criteria exist, you just have to meet them.
Yeah, the denial code matters, it tells you what to fight.
denial reason codes matter, ask for the actual code
the carve-out clause varies by employer
I am going to push back on this slightly.
do not suggest misrepresenting a diagnosis, that is fraud
- 1Mechanistically the bit that matters is prior authorization. It explains…9 comments in this branch · started by u/gustav_vermeulen
- 2External review overturned the denial. Took 20 weeks but the process exists.6 comments in this branch · started by u/nadia_trevino