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c/insurancefights·submitted 1 year ago by u/hassan_chowdhury

prior authorization is the most under-discussed thing in c/glp1muscle

Winbranch of 11 comments

Quick one. Canada here. step therapy 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 20 weeks and cost roughly what I expected. The admin was worse than…

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11 comments, started 1 year ago
u/liv_vukovic-2 points·1 year ago

redact member ids and group numbers from every screenshot

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u/cardio_endpoint_c1 point·1 year ago·edited

Disagree. What you are describing is consistent with formulary, not with what you concluded.

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u/adaeze_weiss1 point·1 year ago

Which plan type? denial is different.

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u/marta_vanhecke1 point·1 year ago

Which plan type?

Yes, exactly this, and it is the bit that took me 46 weeks to accept.

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u/hassan_chowdhuryOP1 point·1 year ago

say which country and which plan type

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u/nikhil_asante1 point·1 year ago

the carve-out clause varies by employer

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u/bence_zielinski1 point·1 year ago

I am going to push back on this slightly.

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u/blunt_coldbox_notes1 point·1 year ago

This is correct. Appeal letters work.

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u/cato_achebe1 point·1 year ago·edited

prior auth criteria are state-specific, denial differs

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u/tuva_kirchner-3 points·1 year ago

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

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u/hassan_chowdhuryOP1 point·1 year ago

Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.

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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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