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

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

Winbranch of 4 comments

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…

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4 comments, started 18 days ago
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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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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