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

formulary is the most under-discussed thing in c/cagrilintide

Discussionbranch of 10 comments

Posting this because I searched for it and got nothing useful. Setup: 10mg, week 62, injection-site soreness present but not ruining anything. I changed exactly one variable — appeal — and tracked it for 22 weeks. Result: a difference, but a small one, and well inside what I would call noise if someone else posted…

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10 comments, started 2 years ago
u/plain_titration_202442 points·2 years ago

say which country and which plan type

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u/hplc_hobbyistruns their own column33 points·2 years ago·edited

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

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[removed]21 points·2 years ago

[removed by moderator]

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u/canada_coverage11 points·2 years ago

appeal letter templates are in the wiki

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u/step_therapy_sMOD19 points·2 years ago

Tracking number removed. It identifies both ends of a shipment.

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u/plain_titration_202428 points·2 years ago

Disagree. What you are describing is consistent with denial, not with what you concluded.

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u/line_petrov10 points·2 years ago

Disagree.

Disagree on that part. 99.2% and 96.2% on the same vial is normal.

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u/marta_vanheckeOP10 points·2 years ago

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

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u/arne_amankwah12 points·2 years ago

Disagree.

Yes, exactly this, and it is the bit that took me 8 weeks to accept.

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u/cardio_endpoint_c3 points·2 years ago

do not suggest misrepresenting a diagnosis, that is fraud

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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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