reading private plan threads from 2024 and half of it aged badly
reading private plan threads from 2024 and half of it aged badly. Not a hot take, just something I have not seen said plainly here.
Kept every form and reference number. When they had no record of a submission, I did.
The pharmacist sorted in five minutes what the phone line had not managed in a fortnight.
Compared cash prices across four pharmacies before pursuing coverage and the spread was larger than I expected.
Research-use-only material is not approved for human use and nothing here should be read as a recommendation to use it.
best — the order this archive was captured in
Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.
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Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.
Disagree — that is your province’s formulary position and it does not carry to another.
a denial letter names a criterion, that is your handle
Read the special authorization criteria and wrote the application against them line by line. Approved first time after a previous refusal.
Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.
Was this a denied authorization or a rejected claim?
Left up. It distinguishes a rejected claim from a denied authorization, which most posts here do not.
a rejected claim is not the same as a denied authorization
Is there a quantity limit involved rather than a coverage refusal?
- 1Employer-sponsored plans have their own criteria and appeal processes,…7 comments in this branch · started by u/nikhil_asante