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c/insurancefights·posted 6 months ago by u/appeal_letter_al

reading external review threads from 2024 and half of it aged badly

Question Clean Column ×5 Slow Clap ×1

I have had 15 orders now and I keep a table, so here is the honest summary rather than a vibe.

Material has been consistent. Communication has not. Shipping has varied by about 36 days on nominally the same lane, which matters more in summer than in February.

The independent number came back 97.9% against a claimed 98.0%, which I read as agreement rather than a discrepancy — inter-lab variance on this assay is a point or two either way and treating one lab as ground truth is how people end up in pointless arguments with vendors.

Batch number is in the comments. Ask if you want the method.

1,951 up / 283 down87% upvoted23 commentsid 1eiqee26 Jan 2026

23 comments

14 in this archive, depth 4

best — the order this archive was captured in

u/rekha_vestergaard231 points·6 months ago

Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.

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u/jarno_adeyemi142 points·6 months ago·edited

Three years on this site and the questions have not changed at all. Which is depressing or reassuring depending on the day.

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u/hamza_weiss78 points·6 months ago

the UK plan: step therapy required 19 medications first. Did them all, got approval. The order matters.

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u/janoshik_junkieindependent tester206 points·6 months ago

Three years on this site and the questions have not changed at all.

Disagree on that part. 99.0% and 98.9% on the same vial is normal.

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u/teodor_duarte112 points·6 months ago·edited

Disagree but this is the good kind of wrong — it is specific enough to be checked.

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u/bence_zielinski47 points·6 months ago

copay is separate from coverage

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u/cardio_endpoint_c31 points·6 months ago

appeal letter templates are in the wiki

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u/rekha_mbeki10 points·6 months ago·edited

do not suggest misrepresenting a diagnosis, that is fraud

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u/honest_syringe199 points·6 months ago

This is correct. Appeal letters work.

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u/ilias_cabrera107 points·6 months ago

say which country and which plan type

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u/rekha_vestergaard83 points·6 months ago

say which country and which plan type

Adding to this: copay is doing more work than the comment implies.

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[removed]59 points·6 months ago

[removed by moderator]

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u/rekha_vestergaard20 points·6 months ago

denial reason codes matter, ask for the actual code

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u/appeal_letter_alOP31 points·6 months ago

Denied for prior auth, resubmitted with external review documentation, approved on appeal. The criteria exist, you just have to meet them.

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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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c/insurancefights rules
  1. Say which country and which plan type. "Insurance" means eleven different things.
  2. Redact member ids and group numbers from every screenshot.
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