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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 5 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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5 comments, started 1 year ago
u/RetaAndRegret2391 points·1 year ago

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

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u/elise_grimaldi245 points·1 year ago

That is net peptide content, not purity. Different number, different meaning.

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u/amylin_amyamylin100 points·1 year ago

the carve-out clause varies by employer

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u/peak_area_peteanalytical116 points·1 year ago·edited

Small correction: the trial was 22 weeks, not 12. Does not change your point but people will quote 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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