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3.2k

my ALT moved and I cannot work out whether step therapy is why

Win Slow Clap ×9 Receipts ×2 Clean Column ×1

Confession thread, sort of.

I went from 7.5mg to 2.4mg much faster than I should have because the scale had stalled and I got impatient. The stall broke about 19 weeks later, at which point I had no way of knowing whether the dose increase did anything or whether it would have broken anyway.

So now I have early fullness I did not need and a data point I cannot interpret. Two lessons in one.

Posting it in the hope that somebody at week 5 reads it before doing the same thing.

3,541 up / 351 down91% upvoted45 commentsid ct58rd4 Mar 2024

45 comments

19 in this archive, depth 6

best — the order this archive was captured in

u/maren_ibarra0 points·2 years ago

formulary exclusions are negotiable sometimes

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u/hassan_castellanosOP1 point·2 years ago

Which plan type? appeal is different.

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u/muscle_cramp_mo1 point·2 years ago

Which plan type?

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

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u/ahmed_abubakar320 points·2 years ago

Did you get step therapy or outright denial?

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u/ferran_batista255 points·2 years ago·edited

say which country and which plan type

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u/milos_vestergaard124 points·2 years ago

denial reason codes matter, ask for the actual code

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u/hassan_castellanosOP62 points·2 years ago

External review overturned the denial. Took 24 weeks but the process exists.

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u/camila_vasquez144 points·2 years ago

Copay was denial for the copay then another 21% of the total. Read the actual plan document.

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u/oskar_kaufmann-28 points·2 years ago

Every time this gets posted it hits the front page and every time someone has to re-explain it.

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u/sock_puppet_spotter1 point·2 years ago

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

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u/oskar_kaufmann1 point·2 years ago

Which state? Coverage varies.

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u/tuva_aalto1 point·2 years ago

redact member ids and group numbers from every screenshot

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u/hplc_hobbyistruns their own column1 point·2 years ago

Which state?

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

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u/sanne_novak1 point·2 years ago

formulary exclusions are negotiable sometimes

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u/line_petrov1 point·2 years ago

Which state? Coverage varies.

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u/ferritin_low71 points·2 years ago

Three years on this site and the questions have not changed at all. Which is depressing or reassuring depending on the day.

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u/amara_haddad50 points·2 years ago

Slight fix: the number was 95.1, not 94.2. Decimal point, but a fairly consequential one.

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u/hassan_castellanosOP38 points·2 years ago

External review overturned the denial. Took 4 weeks but the process exists.

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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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