formulary is the most under-discussed thing in c/coldchain
Something I noticed reading old threads that I have not seen said out loud.
The advice on copay in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers with the same confidence.
I have listed what I think the current consensus is below. Correct me — that is the point of posting it.
best — the order this archive was captured in
redact member ids and group numbers from every screenshot
Disagree but this is the good kind of wrong — it is specific enough to be checked.
prior auth criteria are state-specific, formulary differs
Which plan type? step therapy is different.
formulary exclusions are negotiable sometimes
Small correction: the trial was 15 weeks, not 19. Does not change your point but people will quote it.
This is correct. Appeal letters work.
Denied for prior auth, resubmitted with external review documentation, approved on appeal. The criteria exist, you just have to meet them.
Retitled to remove editorialising. Put the evidence in the body.
prior auth criteria are state-specific, copay differs
appeal letter templates are in the wiki
No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.
Small correction: the trial was 3 weeks, not 27. Does not change your point but people will quote it.
do not suggest misrepresenting a diagnosis, that is fraud
Which plan type? prior authorization is different.
Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.
The practical rule people converge on is 28 days at fridge temperature after first puncture, and that comes from the preservative, not the peptide.
denial reason codes matter, ask for the actual code
Which plan type? copay is different.
denial reason codes matter, ask for the actual code
- 1Denied for prior auth, resubmitted with external review documentation,…9 comments in this branch · started by u/sofia_ferreira
- 2redact member ids and group numbers from every screenshot7 comments in this branch · started by u/marta_vanhecke