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c/insurancefights·submitted 2 years ago by u/kaia_cabrera

stalled for 6 weeks at 2.4mg and I refuse to panic this time

Appealbranch of 7 comments

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…

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7 comments, started 2 years ago
u/ismael_nwosu97 points·2 years ago

External review overturned the denial. Took 22 weeks but the process exists.

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u/marta_vanhecke69 points·2 years ago

Yeah, the denial code matters, it tells you what to fight.

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u/vikram_mbeki34 points·2 years ago

the carve-out clause varies by employer

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u/emeka_delgado17 points·2 years ago

step therapy documentation is the weapon, use it

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u/neha_erdogan13 points·2 years ago

Did you get step therapy or outright denial?

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u/marisol_moreau72 points·2 years ago

External review overturned the denial.

Yes, exactly this, and it is the bit that took me 74 weeks to accept.

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u/marta_dziedzic36 points·2 years ago

the carve-out clause varies by employer

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About c/insurancefights

The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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