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c/insurancefights·posted 11 months ago by u/ines_krastev

the formulary thing finally clicked for me and I want to write it down

Appeal Sourced ×4 Slow Clap ×3

Been lurking in c/glp1eu for about 2 months and finally have something worth posting.

Short version: week 90, 7.5mg, and external review is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 29 threads, and the answers split roughly down the middle.

What I actually want to know is whether the people saying it does not matter have measured it, or whether it is just repeated confidently. Happy to be told I am overthinking this — I probably am — but I would rather overthink it now than at week 96.

1,217 up / 233 down84% upvoted41 commentsid 1esjp322 Aug 2025

41 comments

11 in this archive, depth 5

best — the order this archive was captured in

u/adaeze_weiss83 points·11 months ago

resubmission after denial requires new documentation

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[removed]62 points·11 months ago

[removed by moderator]

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u/ireland_drugs_pay25 points·11 months ago·edited

external review is the appeal after insurance says no

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u/blunt_coldbox_notes32 points·11 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/marisol_moreau38 points·11 months ago

Which plan type? prior authorization is different.

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u/honest_syringe1918 points·11 months ago

external review is the appeal after insurance says no

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u/sock_puppet_spotter66 points·11 months ago

This is correct. Appeal letters work.

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u/ines_krastevOP28 points·11 months ago

Poland plan: step therapy required 2 medications first. Did them all, got approval. The order matters.

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u/ines_krastevOP-24 points·11 months ago

External review overturned the denial. Took 20 weeks but the process exists.

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u/purity_pedantanalytical65 points·11 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/ferritin_low28 points·11 months ago

This is correct. Appeal letters work.

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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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