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c/insurancefights·submitted 8 months ago by u/neha_rahimi

[Meta] the prior authorization rule is doing its job and people should stop complaining

Appealbranch of 7 comments

Right, the denial question again, but with numbers this time. I have 7 data points over 20 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign. The thing I would flag for anyone new: the effect I am describing…

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7 comments, started 8 months ago
u/plain_titration11 points·8 months ago

Sceptical. If this were true we would see it reflected in the data and we do not.

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u/sanne_novak9 points·8 months ago

formulary exclusions are negotiable sometimes

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u/curious_panel_only7 points·8 months ago

Sceptical.

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

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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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