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c/insurancefights·posted 1 year ago by u/elin_varga

[Vendor] WXT order #9 — the Netherlands, 17 days, no drama, receipts inside

Win Slow Clap ×2 Receipts ×1 Well Actually ×3

Been lurking in c/glp1eu for about 9 months and finally have something worth posting.

Short version: week 11, 0.5mg, and external review is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 7 threads, and the answers split roughly down the middle.

What I actually want to know is whether the people saying it does not matter have measured it, or whether it is just repeated confidently. Happy to be told I am overthinking this — I probably am — but I would rather overthink it now than at week 17.

3,823 up / 189 down95% upvoted68 commentsid bdxtlb17 Oct 2024

68 comments

30 in this archive, depth 4

best — the order this archive was captured in

u/janoshik_junkieindependent tester403 points·1 year ago

formulary exclusions are negotiable sometimes

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u/adaeze_weiss269 points·1 year ago

formulary exclusions are negotiable sometimes

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

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u/maren_ibarra0 points·1 year ago

step therapy documentation is the weapon, use it

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u/sofia_ferreira1 point·1 year ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/bence_zielinski378 points·1 year ago

denial reason codes matter, ask for the actual code

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u/ismael_nwosu214 points·1 year ago

Water content matters more than people think. If a vial is carrying residual moisture, your "10mg" is not 10mg of peptide.

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u/appeal_letter_alMOD174 points·1 year ago·edited

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

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u/karim_restrepo159 points·1 year ago

This is the "correlation is mechanism" thing again. You changed three variables at once.

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u/cato_achebe58 points·1 year ago·edited

resubmission after denial requires new documentation

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u/plain_titration117 points·1 year ago

Did you get step therapy or outright denial?

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u/elin_vargaOP70 points·1 year ago

External review overturned the denial. Took 2 weeks but the process exists.

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u/hassan_castellanos89 points·1 year ago

Did you get step therapy or outright denial?

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

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u/sock_puppet_spotter26 points·1 year ago

formulary exclusions are negotiable sometimes

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u/hassan_chowdhury0 points·1 year ago

What was the denial code?

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u/whois_wanda63 points·1 year ago

Which plan type? step therapy is different.

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u/ignacio_vanhecke27 points·1 year ago·edited

Which plan type?

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

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u/amira_dumitru14 points·1 year ago

formulary exclusions are negotiable sometimes

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u/formulary_fighterappeals11 points·1 year ago

appeal letter templates are in the wiki

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u/elin_vargaOP48 points·1 year ago

external review is the appeal after insurance says no

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u/peak_area_peteanalytical15 points·1 year ago·edited

prior auth criteria are state-specific, appeal differs

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u/elise_grimaldi21 points·1 year ago

Which plan type?

Yes, exactly this, and it is the bit that took me 78 weeks to accept.

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u/slow_logbook_notes36 points·1 year ago

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

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u/bence_zielinski13 points·1 year ago

That is net peptide content, not purity. Different number, different meaning.

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u/kasper_cabrera30 points·1 year ago

Did you get step therapy or outright denial?

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u/tuva_kirchner9 points·1 year ago

step therapy documentation is the weapon, use it

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u/milan_wikstrom13 points·1 year ago

external review is the appeal after insurance says no

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u/kaia_cabrera4 points·1 year ago

Respectfully this is a sample of one presented as a finding.

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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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