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c/insurancefights·submitted 4 months ago by u/honest_syringe19

[Results] 81 weeks on 2.4mg, full numbers, ask me anything boring

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Right, the formulary question again, but with numbers this time. I have 6 data points over 10 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign. The thing I would flag for anyone new: the effect I am…

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8 comments, started 4 months ago
u/appeal_letter_alMOD7 points·4 months ago

Flair changed to match the content. Read the sidebar before posting next time and we are square.

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u/liv_vukovic5 points·4 months ago

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

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u/honest_syringe19OP4 points·4 months ago

denial reason codes matter, ask for the actual code

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u/honest_syringe19OP2 points·4 months ago

External review overturned the denial. Took 7 weeks but the process exists.

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u/honest_syringe19OP3 points·4 months ago

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

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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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