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c/insurancefights·submitted 1 year ago by u/amira_dumitru

[Discussion] the appeal advice in here is 3 years out of date

Discussionbranch of 4 comments

formulary. That is the whole post, but I will justify it. Everything else people worry about in c/meta is downstream of it. Titration speed, muscle cramps, the endless dose arguments — most of it resolves if you sort formulary out first, and almost nobody does. I say this having got it wrong for 3 months. My hs-CRP…

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4 comments, started 1 year ago
u/step_therapy_sMOD142 points·1 year ago

Retitled to remove editorialising. Put the evidence in the body.

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u/karim_restrepo95 points·1 year ago

Not to be pedantic but copay and step therapy are being used interchangeably and they are not interchangeable in real life.

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u/solene_eriksen25 points·1 year ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/amira_dumitruOP-15 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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