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

[Meta] proposal — a flair for formulary posts

Discussionbranch of 10 comments

I have had 2 orders now and I keep a table, so here is the honest summary rather than a vibe. Material has been consistent. Communication has not. Shipping has varied by about 20 days on nominally the same lane, which matters more in summer than in February. The independent number came back 96.8% against a claimed…

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10 comments, started 1 year ago
u/honest_syringe1985 points·1 year ago

step therapy documentation is the weapon, use it

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u/RetaAndRegret259 points·1 year ago

I am going to push back on this slightly.

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u/gustav_vermeulenOP18 points·1 year ago

step therapy documentation is the weapon, use it

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u/nnt_nate49 points·1 year ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/pavel_nkemelu67 points·1 year ago

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

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u/neha_erdogan11 points·1 year ago

the carve-out clause varies by employer

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u/jarno_adeyemi5 points·1 year ago

say which country and which plan type

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u/vito_beaulieu23 points·1 year ago

resubmission after denial requires new documentation

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u/ismael_nwosu16 points·1 year ago

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

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u/appeal_letter_al23 points·1 year ago

denial reason codes matter, ask for the actual code

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About c/insurancefights

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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