[Results] 7 weeks, 41kg, and formulary was the hard part
appeal. That is the whole post, but I will justify it.
Everything else people worry about in c/meta is downstream of it. Titration speed, early fullness, the endless dose arguments — most of it resolves if you sort appeal out first, and almost nobody does.
I say this having got it wrong for 15 months. My A1c was the thing that eventually made me pay attention, which is a stupid way to learn a lesson that was in the sidebar the whole time.
best — the order this archive was captured in
This is an urgent-care question wearing a forum question's clothes. Please contact a clinician rather than waiting for replies.
the carve-out clause varies by employer
This is an urgent-care question wearing a forum question's clothes.
Yes, exactly this, and it is the bit that took me 72 weeks to accept.
Strongly agree. Step therapy is predictable if you have the criteria.
Which state? Coverage varies.
Denied for prior auth, resubmitted with external review documentation, approved on appeal. The criteria exist, you just have to meet them.
Yeah, the denial code matters, it tells you what to fight.
Water content matters more than people think. If a vial is carrying residual moisture, your "10mg" is not 10mg of peptide.
step therapy documentation is the weapon, use it
the carve-out clause varies by employer
formulary exclusions are negotiable sometimes
redact member ids and group numbers from every screenshot
prior auth criteria are state-specific, formulary differs
do not suggest misrepresenting a diagnosis, that is fraud
This is the "correlation is mechanism" thing again. You changed three variables at once.
formulary exclusions are negotiable sometimes
Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.
This is correct. Appeal letters work.
Which plan type? copay is different.
Disagree but this is the good kind of wrong — it is specific enough to be checked.
external review is the appeal after insurance says no
The evidence standard in c/vendorvetting gets called too strict about once a month, and every time, the thread ends with the complainant agreeing.
The confident tone is doing a lot of work that the evidence is not.
do not suggest misrepresenting a diagnosis, that is fraud
This is correct. Appeal letters work.
- 1IANAD and neither is anyone upvoting this6 comments in this branch · started by u/maren_ibarra
- 2Water content matters more than people think. If a vial is carrying residual…5 comments in this branch · started by u/tidy_vialdrawer_watch