denial: the version I wish someone had shown me in week 1
Quick one. Canada here.
prior authorization works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US.
Specifics: the route I used took 17 weeks and cost roughly what I expected. The admin was worse than the cost. The thing that would have saved me the most time was knowing which document to ask for at the start.
Happy to answer questions from anyone in the same jurisdiction.
best — the order this archive was captured in
Denied for prior auth, resubmitted with denial documentation, approved on appeal. The criteria exist, you just have to meet them.
redact member ids and group numbers from every screenshot
Which plan type? copay is different.
I love that this community will spend 40 comments on a detail. That pedantry is why the numbers here matter.
The confident tone is doing a lot of work that the evidence is not.
Yeah, the denial code matters, it tells you what to fight.
This is correct. Appeal letters work.
Which plan type? formulary is different.
This is an urgent-care question wearing a forum question's clothes. Please contact a clinician rather than waiting for replies.
Small correction: the trial was 11 weeks, not 24. Does not change your point but people will quote it.
That is net peptide content, not purity. Different number, different meaning.
Yeah, the denial code matters, it tells you what to fight.
do not suggest misrepresenting a diagnosis, that is fraud
Dead space in the needle hub holds a small but non-trivial volume. On low-volume draws that can be several units.
formulary exclusions are negotiable sometimes
Strongly agree. Step therapy is predictable if you have the criteria.
resubmission after denial requires new documentation
the carve-out clause varies by employer
This is correct. Appeal letters work.
do not suggest misrepresenting a diagnosis, that is fraud
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
This is correct. Appeal letters work.
Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.
- 1the VendorInvestigate number or it did not happen6 comments in this branch · started by u/kasper_cabrera
- 2the carve-out clause varies by employer5 comments in this branch · started by u/osman_ferrari