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c/insurancefights·submitted 11 months ago by u/whois_wanda

the appeal question that gets asked weekly, answered properly

Questionbranch of 4 comments

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,…

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4 comments, started 11 months ago

u/wholesome_lurker148 points·11 months ago

Copay was step therapy for the copay then another 23% of the total. Read the actual plan document.

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u/whois_wandaOP214 points·11 months ago

External review overturned the denial. Took 18 weeks but the process exists.

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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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