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c/insurancefights·posted 19 days ago by u/RetaAndRegret2

[Win] HSA dollars changed the real cost by a third and i nearly missed it

Win Receipts ×2

Long-ish post, sorry. tl;dr at the bottom.

I have been tracking external review against eGFR for 11 weeks because I could not find anyone who had. The correlation is weaker than I expected, which is itself mildly interesting given how confidently people link the two in here.

Caveats up front: one person, one lab, one assay, no control, and I changed my training in the middle of it, which was stupid.

tl;dr: probably real, definitely smaller than the threads imply, and not worth reorganising your week around.

733 up / 79 down90% upvoted22 commentsid boijvw11 Jul 2026

22 comments

22 in this archive, depth 4

best — the order this archive was captured in

u/elin_varga111 points·17 days ago

External review overturned the denial. Took 19 weeks but the process exists.

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u/marta_dziedzic31 points·17 days ago

prior auth criteria are state-specific, appeal differs

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u/sofia_ferreira87 points·17 days ago

Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.

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u/appeal_letter_al66 points·19 days ago

No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.

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u/adaeze_weiss-3 points·18 days ago

step therapy documentation is the weapon, use it

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u/formulary_fighterMOD38 points·18 days ago

Removed a chain here. The rule is one line long and it is not negotiable.

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u/kaia_cabrera12 points·18 days ago·edited

This is correct. Appeal letters work.

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u/emeka_delgado9 points·17 days ago·edited

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

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u/RetaAndRegret2OP6 points·17 days ago

Denied for prior auth, resubmitted with external review documentation, approved on appeal. The criteria exist, you just have to meet them.

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u/vikram_mbeki35 points·18 days ago

Copay was external review for the copay then another 9% of the total. Read the actual plan document.

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u/nadia_trevino15 points·18 days ago

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

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u/teodor_duarte5 points·18 days ago·edited

Titration speed is a side-effect dial far more than an efficacy dial.

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u/elin_varga6 points·18 days ago

appeal letter templates are in the wiki

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u/RetaAndRegret2OP3 points·17 days ago

External review overturned the denial. Took 12 weeks but the process exists.

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u/RetaAndRegret2OP8 points·17 days ago

External review overturned the denial. Took 7 weeks but the process exists.

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u/hedda_aguirre5 points·17 days ago

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

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u/nnt_nate2 points·17 days ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/oskar_kaufmann3 points·17 days ago

step therapy documentation is the weapon, use it

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u/ferran_dahlberg3 points·17 days ago·edited

This is correct. Appeal letters work.

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u/blunt_coldbox_notes1 point·17 days ago

say which country and which plan type

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[removed]6 points·17 days ago

[removed by moderator]

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u/line_petrov17 points·17 days ago

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

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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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