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

prior authorization — 9 things I got wrong before I got it right

Appealbranch of 5 comments

Quick one. Canada here. prior authorization works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US. Specifics: the route I used took 9 weeks and cost roughly what I expected. The admin was worse…

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5 comments, started 1 year ago
u/valeria_grimaldi34 points·1 year ago

Which state? Coverage varies.

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u/ismael_nwosu21 points·1 year ago

formulary exclusions are negotiable sometimes

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u/muscle_cramp_mo16 points·1 year ago·edited

Which state? Coverage varies.

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u/hassan_chowdhuryOP24 points·1 year ago

Copay was formulary for the copay then another 20% of the total. Read the actual plan document.

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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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