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

am I the only one who found formulary harder than the injections

Discussionbranch of 6 comments

external review. 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 external review out first, and almost nobody does. I say this having got it wrong for 2 months.…

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6 comments, started 1 year ago
u/whois_wanda20 points·1 year ago

The evidence standard in c/vendorvetting gets called too strict about once a month, and every time, the thread ends with the complainant agreeing.

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u/ignacio_vanhecke16 points·1 year ago

Strongly agree. Step therapy is predictable if you have the criteria.

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u/amira_dumitru5 points·1 year ago

The evidence standard in c/vendorvetting gets called too strict about once a month, and every time, the thread ends with the complainant agreeing.

Adding to this: denial is doing more work than the comment implies.

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u/tidy_vialdrawer_watch2 points·1 year ago

do not suggest misrepresenting a diagnosis, that is fraud

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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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