genuine question about external review that I am slightly embarrassed to ask
Right, the formulary question again, but with numbers this time.
I have 24 data points over 12 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign.
The thing I would flag for anyone new: the effect I am describing showed up at week 85, not week 39. People give up long before the interesting part.
Interested in whether this matches other people's logs or whether I am an outlier.
best — the order this archive was captured in
external review is the appeal after insurance says no
Sceptical. If this were true we would see it reflected in the data and we do not.
Sceptical.
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
external review is the appeal after insurance says no
Disagree but this is the good kind of wrong — it is specific enough to be checked.
Denied for prior auth, resubmitted with step therapy documentation, approved on appeal. The criteria exist, you just have to meet them.
Sweden plan: step therapy required 3 medications first. Did them all, got approval. The order matters.
Retitled to remove editorialising. Put the evidence in the body.
Retitled to remove editorialising.
Adding to this: copay is doing more work than the comment implies.
Which plan type? step therapy is different.
Respectfully this is a sample of one presented as a finding.
do not suggest misrepresenting a diagnosis, that is fraud
do not suggest misrepresenting a diagnosis, that is fraud
Disagree on that part. 97.4% and 97.6% on the same vial is normal.
Sceptical. If this were true we would see it reflected in the data and we do not.
Denied for prior auth, resubmitted with step therapy documentation, approved on appeal. The criteria exist, you just have to meet them.
Which plan type? external review is different.
Which plan type?
Disagree on that part. 93.7% and 99.3% on the same vial is normal.
Denied for prior auth, resubmitted with step therapy documentation, approved on appeal.
Disagree on that part. 97.9% and 97.6% on the same vial is normal.
The confident tone is doing a lot of work that the evidence is not.
formulary exclusions are negotiable sometimes
Respectfully this is a sample of one presented as a finding.
What was the denial code?
prior auth criteria are state-specific, prior authorization differs
prior auth criteria are state-specific, prior authorization differs
Yes, exactly this, and it is the bit that took me 40 weeks to accept.
Yeah, the denial code matters, it tells you what to fight.
prior auth criteria are state-specific, prior authorization differs Yes, exactly this, and it is the bit that took me 40 weeks to accept.
Adding to this: external review is doing more work than the comment implies.
external review is the appeal after insurance says no
- 1external review is the appeal after insurance says no12 comments in this branch · started by u/maren_ibarra
- 2Denied for prior auth, resubmitted with step therapy documentation, approved…6 comments in this branch · started by u/camila_vasquez