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

denial: what the trials say vs what this community says

Appealbranch of 6 comments

Something I noticed reading old threads that I have not seen said out loud. The advice on formulary 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…

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This branch

6 comments, started 1 year ago
u/ignacio_vanhecke76 points·1 year ago

step therapy documentation is the weapon, use it

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u/marta_marchand25 points·1 year ago

You have restated the marketing copy. What is the actual substance here.

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u/adaeze_cabrera12 points·1 year ago

say which country and which plan type

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u/tuva_kirchner0 points·1 year ago

say which country and which plan type

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

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u/kian_ferreira9 points·1 year ago

say which country and which plan type

Disagree on that part. 95.1% and 99.3% on the same vial is normal.

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u/maren_sorensen6 points·1 year ago

Not to be pedantic but external review and formulary are being used interchangeably and they are not interchangeable in real life.

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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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