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c/insurancefights·posted 1 year ago by u/vito_beaulieu

[Results] 52 weeks, 35kg, and prior authorization was the hard part

Discussion Well Actually ×9 Slow Clap ×1 Cold Box ×2

Posting this because I searched for it and got nothing useful.

Setup: 7.5mg, week 35, sulphur burps present but not ruining anything. I changed exactly one variable — formulary — and tracked it for 12 weeks.

Result: a difference, but a small one, and well inside what I would call noise if someone else posted it. So I am putting it here rather than presenting it as a finding. If two or three other people have done the same thing we might actually learn something.

Not medical advice, obviously. This is one person with a spreadsheet.

3,347 up / 308 down92% upvoted10 commentsid 1f2jas17 Jul 2025

10 comments

7 in this archive, depth 2

best — the order this archive was captured in

u/solene_eriksen196 points·1 year ago

copay is separate from coverage

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u/runa_wikstrom113 points·1 year ago

Copay was step therapy for the copay then another 24% of the total. Read the actual plan document.

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u/line_bergstrom115 points·1 year ago

Yeah, the denial code matters, it tells you what to fight.

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u/vikram_mbeki72 points·1 year ago

say which country and which plan type

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u/step_therapy_sMOD40 points·1 year ago

Tracking number removed. It identifies both ends of a shipment.

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u/purity_pedantanalytical13 points·1 year ago

external review is the appeal after insurance says no

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u/pavel_nkemelu26 points·1 year ago

Strongly agree. Step therapy is predictable if you have the criteria.

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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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