small win: appeal stopped being a problem at week 5
Right, the formulary question again, but with numbers this time.
I have 22 data points over 22 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign.
The thing I would flag for anyone new: the effect I am describing showed up at week 19, not week 68. People give up long before the interesting part.
Interested in whether this matches other people's logs or whether I am an outlier.
best — the order this archive was captured in
Three years on this site and the questions have not changed at all. Which is depressing or reassuring depending on the day.
This is correct. Appeal letters work.
Denied for prior auth, resubmitted with formulary documentation, approved on appeal. The criteria exist, you just have to meet them.
You have restated the marketing copy. What is the actual substance here.
external review is the appeal after insurance says no
denial reason codes matter, ask for the actual code
Sceptical. If this were true we would see it reflected in the data and we do not.
prior auth criteria are state-specific, prior authorization differs
Slight fix: the number was 95.1, not 94.2. Decimal point, but a fairly consequential one.
Yeah, the denial code matters, it tells you what to fight.
resubmission after denial requires new documentation
formulary exclusions are negotiable sometimes
This is correct. Appeal letters work.
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 40 weeks to accept.
Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.
- 1Yeah, the denial code matters, it tells you what to fight.10 comments in this branch · started by u/janoshik_junkie
- 2Three years on this site and the questions have not changed at all. Which is…6 comments in this branch · started by u/tuva_kirchner