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c/insurancefights·posted 6 months ago by u/idris_iyer

is it normal to get nausea at week 64

Appeal Sourced ×1 Slow Clap ×3

Something I noticed reading old threads that I have not seen said out loud.

The advice on copay in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers with the same confidence.

I have listed what I think the current consensus is below. Correct me — that is the point of posting it.

1,940 up / 303 down86% upvoted23 commentsid cryzk57 Jan 2026

23 comments

17 in this archive, depth 5

best — the order this archive was captured in

u/liv_vukovic239 points·6 months ago

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

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u/milan_wikstrom68 points·6 months ago

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

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[deleted]94 points·6 months ago

[deleted]

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u/idris_iyerOP41 points·6 months ago

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

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u/arne_amankwah85 points·6 months ago

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

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u/saskia_lokken269 points·6 months ago

redact member ids and group numbers from every screenshot

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u/osman_ferrari63 points·6 months ago

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

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u/idris_iyerOP152 points·6 months ago

Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.

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u/marta_marchand106 points·6 months ago

Small correction: the trial was 19 weeks, not 33. Does not change your point but people will quote it.

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u/ferritin_low25 points·6 months ago

denial reason codes matter, ask for the actual code

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u/hassan_castellanos102 points·6 months ago·edited

Inter-lab variance on this kind of assay is routinely 1–2 points.

Disagree on that part. 97.9% and 97.6% on the same vial is normal.

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u/hassan_chowdhury75 points·6 months ago·edited

Small correction: the trial was 5 weeks, not 30. Does not change your point but people will quote it.

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u/kian_ferreira53 points·6 months ago

appeal letter templates are in the wiki

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u/gustav_vermeulen133 points·6 months ago

resubmission after denial requires new documentation

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u/hugo_pires66 points·6 months ago

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

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u/hedda_aguirre31 points·6 months ago

Disagree but this is the good kind of wrong — it is specific enough to be checked.

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u/plain_titration_202426 points·6 months ago

Disagree but this is the good kind of wrong — it is specific enough to be checked.

Adding to this: denial is doing more work than the comment implies.

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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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