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c/insurancefights·submitted 4 months ago by u/ines_krastev

Canada: denial, and what it actually costs here

Appealbranch of 7 comments

Been lurking in c/glp1eu for about 16 months and finally have something worth posting. Short version: week 60, 15mg, and appeal is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 37 threads, and the answers split roughly down the middle. What I actually want to know is…

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7 comments, started 4 months ago
u/controversial_only15 points·4 months ago

Crossposting this to c/cryptopay because the people who need it are not reading this community.

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u/ines_krastevOP-30 points·4 months ago

copay is separate from coverage

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u/hamza_weiss6 points·4 months ago

Which plan type? step therapy is different.

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u/ines_krastevOP3 points·4 months ago

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

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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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