stalled for 6 weeks at 2.4mg and I refuse to panic this time
Quick one. Canada here.
denial 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 2 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 external review documentation, approved on appeal. The criteria exist, you just have to meet them.
Flair changed to match the content. Read the sidebar before posting next time and we are square.
appeal letter templates are in the wiki
appeal letter templates are in the wiki
Adding to this: prior authorization is doing more work than the comment implies.
Did you get step therapy or outright denial?
Not to be pedantic but appeal and copay are being used interchangeably and they are not interchangeable in real life.
Denied for prior auth, resubmitted with external review documentation, approved on appeal. The criteria exist, you just have to meet them.
external review is the appeal after insurance says no
Poland plan: step therapy required 23 medications first. Did them all, got approval. The order matters.
copay is separate from coverage
redact member ids and group numbers from every screenshot
copay is separate from coverage
The practical rule people converge on is 28 days at fridge temperature after first puncture, and that comes from the preservative, not the peptide.
External review overturned the denial. Took 22 weeks but the process exists.
Yeah, the denial code matters, it tells you what to fight.
step therapy documentation is the weapon, use it
Did you get step therapy or outright denial?
External review overturned the denial.
Yes, exactly this, and it is the bit that took me 74 weeks to accept.
the carve-out clause varies by employer
prior auth criteria are state-specific, step therapy differs
denial reason codes matter, ask for the actual code
Strongly agree. Step therapy is predictable if you have the criteria.
No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.
say which country and which plan type
- 1Denied for prior auth, resubmitted with external review documentation,…8 comments in this branch · started by u/saskia_rahimi
- 2External review overturned the denial. Took 22 weeks but the process exists.7 comments in this branch · started by u/ismael_nwosu