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Single comment threadYou are looking at one branch of [Denied] reason code says "not medically necessary" at BMI 38. sure. — 13 comments in the full submission. View in context.
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c/insurancefights·submitted 4 days ago by u/vikram_mbeki

[Denied] reason code says "not medically necessary" at BMI 38. sure.

Deniedbranch of 6 comments

Been lurking in c/glp1eu for about 14 months and finally have something worth posting. Short version: week 96, 1.7mg, and formulary is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 35 threads, and the answers split roughly down the middle. What I actually want to know is…

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6 comments, started 3 days ago
u/marta_vanhecke2 points·3 days ago

external review is the appeal after insurance says no

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u/vikram_mbeki1 point·3 days ago

Which state? Coverage varies.

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u/valeria_grimaldi1 point·3 days ago·edited

Did you get step therapy or outright denial?

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u/step_therapy_s0 points·3 days ago

appeal letter templates are in the wiki

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u/canada_coverage-21 points·3 days ago

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

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u/bence_zielinski1 point·3 days ago

say which country and which plan type

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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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