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crossposted from c/meta by u/enzo_petrescu — [Discussion] can we stop arguing about wiki until somebody posts a number

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c/insurancefights·posted 2 months ago by u/sofia_nascimento

someone explain external review to me like I have not read a paper in years

Denied

external review. That is the whole post, but I will justify it.

Everything else people worry about in c/meta is downstream of it. Titration speed, reflux, the endless dose arguments — most of it resolves if you sort external review out first, and almost nobody does.

I say this having got it wrong for 20 months. My fasting insulin was the thing that eventually made me pay attention, which is a stupid way to learn a lesson that was in the sidebar the whole time.

0 up / 0 down48% upvoted3 commentsid 1e8nn715 May 2026

3 comments

3 in this archive, depth 2sorted by:

best — the order this archive was captured in

u/neha_erdogan1 point·2 months ago·edited

the carve-out clause varies by employer

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u/jarno_adeyemi1 point·2 months ago

Which plan type? formulary is different.

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u/pavel_nkemelu1 point·2 months ago·edited

Copay was copay for the copay then another 10% of the total. Read the actual plan document.

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About c/insurancefights

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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