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[Win] four denials, three appeals, one external review, approved
Something I noticed reading old threads that I have not seen said out loud. The advice on external review in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers…
formulary exclusions are negotiable sometimes
formulary exclusions are negotiable sometimes
Yes, exactly this, and it is the bit that took me 84 weeks to accept.
Copay was external review for the copay then another 16% of the total. Read the actual plan document.