the copay question that gets asked weekly, answered properly
Long-ish post, sorry. tl;dr at the bottom.
I have been tracking denial against eGFR for 21 weeks because I could not find anyone who had. The correlation is weaker than I expected, which is itself mildly interesting given how confidently people link the two in here.
Caveats up front: one person, one lab, one assay, no control, and I changed my training in the middle of it, which was stupid.
tl;dr: probably real, definitely smaller than the threads imply, and not worth reorganising your week around.
best — the order this archive was captured in
This is correct. Appeal letters work.
Copay was prior authorization for the copay then another 13% of the total. Read the actual plan document.
New Zealand plan: step therapy required 24 medications first. Did them all, got approval. The order matters.
external review is the appeal after insurance says no
Yeah, the denial code matters, it tells you what to fight.
Small correction: the trial was 20 weeks, not 18. Does not change your point but people will quote it.
This is correct. Appeal letters work.
step therapy documentation is the weapon, use it
formulary exclusions are negotiable sometimes
External review overturned the denial. Took 16 weeks but the process exists.
prior auth criteria are state-specific, copay differs
Sceptical. If this were true we would see it reflected in the data and we do not.
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resubmission after denial requires new documentation
do not suggest misrepresenting a diagnosis, that is fraud
appeal letter templates are in the wiki
do not suggest misrepresenting a diagnosis, that is fraud
I love that this community will spend 40 comments on a detail. That pedantry is why the numbers here matter.
Yeah, the denial code matters, it tells you what to fight.
This is correct. Appeal letters work.
- 1This is correct. Appeal letters work.8 comments in this branch · started by u/sanne_novak
- 2This is correct. Appeal letters work.4 comments in this branch · started by u/milan_wikstrom