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

[Results] 17 weeks, 36kg, and denial was the hard part

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Long-ish post, sorry. tl;dr at the bottom. I have been tracking appeal against ApoB for 17 weeks because I could not find anyone who had. The correlation is weaker than I expected, which is itself mildly interesting given how confidently people link the two in here. Caveats up front: one person, one lab, one assay,…

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7 comments, started 1 year ago
u/idris_iyer-32 points·1 year ago

resubmission after denial requires new documentation

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u/hassan_chowdhury-38 points·1 year ago

Did you get step therapy or outright denial?

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u/saskia_lokken1 point·1 year ago

step therapy documentation is the weapon, use it

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u/plain_titration1 point·1 year ago

Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.

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u/sofia_nascimentoOP1 point·1 year ago

external review is the appeal after insurance says no

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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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