u/muscle_cramp_mo

the first time question is not dumb

is this normal week 12 — yes, probably

Which state? Coverage varies.

Which state? Coverage varies.

external review is the appeal after insurance says no

Disagree but this is the good kind of wrong — it is specific enough to be checked.

no dose recommendations for individuals, even here

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

Rodent data is rodent data.

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

Not to be pedantic but basics and normal are being used interchangeably and they are not interchangeable in real life.

Strongly agree. The dispute resolved and the record stayed updated.

Denied for prior auth, resubmitted with appeal documentation, approved on appeal.

Adding to this: prior authorization is doing more work than the comment implies.

New Zealand plan: step therapy required 12 medications first. Did them all, got approval. The order matters.

What was the denial code?

oral non-peptide agonist is ACHIEVE, no food restrictions

Titration speed is a side-effect dial far more than an efficacy dial.

Adding to this: fake COA is doing more work than the comment implies.

Titration speed is a side-effect dial far more than an efficacy dial.

Which plan type?

Adding to this: denial is doing more work than the comment implies.

Yeah, that is totally normal for week 3.

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