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Single comment threadYou are looking at one branch of week 21 check-in — 37kg down, early fullness manageable, one thing confusing me — 62 comments in the full submission. View in context.
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c/insurancefights·submitted 5 months ago by u/step_therapy_s

week 21 check-in — 37kg down, early fullness manageable, one thing confusing me

Appealbranch of 9 comments

Quick one. Canada here. formulary works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US. Specifics: the route I used took 22 weeks and cost roughly what I expected. The admin was worse than the…

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9 comments, started 5 months ago
u/gustav_vermeulen50 points·5 months ago

Mechanistically the bit that matters is prior authorization. It explains most of the early profile and a decent chunk of the outcome.

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u/step_therapy_sOP26 points·5 months ago

Denied for prior auth, resubmitted with copay documentation, approved on appeal. The criteria exist, you just have to meet them.

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u/pavel_nkemelu21 points·5 months ago·edited

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

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u/neha_erdogan6 points·5 months ago

denial reason codes matter, ask for the actual code

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u/oskar_kaufmann2 points·5 months ago·edited

the carve-out clause varies by employer

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u/solene_eriksen1 point·5 months ago

say which country and which plan type

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u/hugo_pires19 points·5 months ago

copay is separate from coverage

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u/emeka_delgado24 points·5 months ago

I am going to push back on this slightly.

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u/vito_beaulieu68 points·5 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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