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c/insurancefights·submitted 5 months ago by u/tuva_kirchner

[Results] 7 weeks, 41kg, and formulary was the hard part

Discussionbranch of 6 comments

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…

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6 comments, started 5 months ago
u/maren_ibarra38 points·5 months ago
IANAD and neither is anyone upvoting this
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u/ismael_nwosu29 points·5 months ago

redact member ids and group numbers from every screenshot

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u/karim_restrepo10 points·5 months ago

prior auth criteria are state-specific, formulary differs

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u/nadia_trevino5 points·5 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/ferritin_low11 points·5 months ago·edited

This is the "correlation is mechanism" thing again. You changed three variables at once.

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u/maren_sorensen22 points·5 months ago

formulary exclusions are negotiable sometimes

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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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