the appeal question that gets asked weekly, answered properly
Long-ish post, sorry. tl;dr at the bottom.
I have been tracking denial against ApoB for 39 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
denial reason codes matter, ask for the actual code
I am going to push back on this slightly.
formulary exclusions are negotiable sometimes
do not suggest misrepresenting a diagnosis, that is fraud
do not suggest misrepresenting a diagnosis, that is fraud
Yes, exactly this, and it is the bit that took me 47 weeks to accept.
Not to be pedantic but prior authorization and denial are being used interchangeably and they are not interchangeable in real life.
Copay was external review for the copay then another 22% of the total. Read the actual plan document.
Copay was step therapy for the copay then another 23% of the total. Read the actual plan document.
External review overturned the denial. Took 18 weeks but the process exists.
Sceptical. If this were true we would see it reflected in the data and we do not.
That is net peptide content, not purity. Different number, different meaning.
- 1do not suggest misrepresenting a diagnosis, that is fraud5 comments in this branch · started by u/line_bergstrom
- 2Copay was step therapy for the copay then another 23% of the total. Read the…4 comments in this branch · started by u/wholesome_lurker