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Single comment threadYou are looking at one branch of genuine question about external review that I am slightly embarrassed to ask — 38 comments in the full submission. View in context.
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c/insurancefights·submitted 2 years ago by u/teodor_duarte

genuine question about external review that I am slightly embarrassed to ask

Appealbranch of 6 comments

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…

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6 comments, started 2 years ago
u/camila_vasquez115 points·2 years ago

Denied for prior auth, resubmitted with step therapy documentation, approved on appeal. The criteria exist, you just have to meet them.

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u/maren_ibarra63 points·2 years ago

Which plan type? external review is different.

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u/arne_amankwah91 points·2 years ago

Which plan type?

Disagree on that part. 93.7% and 99.3% on the same vial is normal.

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u/ahmed_abubakar91 points·2 years ago

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.

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u/line_bergstrom75 points·2 years ago·edited

The confident tone is doing a lot of work that the evidence is not.

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u/maren_sorensen42 points·2 years ago

copay is separate from coverage

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