switched from 15mg to 1.0mg and the reflux got better, not worse
Trying to settle this properly because the thread from last year went in circles.
The claim: formulary matters. The counter-claim: it is measurement error. Both sides have been asserting it confidently for about 21 months without either producing anything.
What would actually settle it is 23 people measuring the same thing the same way. I have started; my numbers are below. They lean one way but not strongly enough for me to declare victory.
If you have data, post the data. If you have an opinion, flair it as an opinion.
best — the order this archive was captured in
Half-life is about 168 hours, so steady state lands around week 11–5. Practical consequence: what you feel in week 1 is not what that dose does.
step therapy documentation is the weapon, use it
Yeah, the denial code matters, it tells you what to fight.
Small correction: the trial was 12 weeks, not 16. Does not change your point but people will quote it.
What was the denial code?
denial reason codes matter, ask for the actual code
[removed by moderator]
Yeah, the denial code matters, it tells you what to fight.
formulary exclusions are negotiable sometimes
Retitled to remove editorialising. Put the evidence in the body.
Strongly agree. Step therapy is predictable if you have the criteria.
external review is the appeal after insurance says no
Not convinced. The evidence does not support that reading.
say which country and which plan type
say which country and which plan type
Adding to this: appeal is doing more work than the comment implies.
External review overturned the denial. Took 17 weeks but the process exists.
redact member ids and group numbers from every screenshot
This is correct. Appeal letters work.
Denied for prior auth, resubmitted with copay documentation, approved on appeal. The criteria exist, you just have to meet them.
external review is the appeal after insurance says no
prior auth criteria are state-specific, appeal differs
do not suggest misrepresenting a diagnosis, that is fraud
- 1What was the denial code?6 comments in this branch · started by u/slow_logbook_notes
- 2external review is the appeal after insurance says no5 comments in this branch · started by u/ismael_nwosu