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Single comment threadYou are looking at one branch of [Discussion] can we stop arguing about external review until somebody posts a number — 14 comments in the full submission. View in context.
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c/insurancefights·submitted 1 months ago by u/neha_rahimi

[Discussion] can we stop arguing about external review until somebody posts a number

Discussionbranch of 5 comments

I have had 13 orders now and I keep a table, so here is the honest summary rather than a vibe. Material has been consistent. Communication has not. Shipping has varied by about 10 days on nominally the same lane, which matters more in summer than in February. The independent number came back 93.7% against a claimed…

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5 comments, started 1 months ago
u/formulary_fighterappeals10 points·1 months ago

Did you get step therapy or outright denial?

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u/neha_rahimiOP12 points·1 months ago

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

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u/line_bergstrom8 points·1 months ago·edited

formulary exclusions are negotiable sometimes

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u/coring_the_stopper3 points·1 months ago

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

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u/adaeze_cabrera5 points·1 months ago

Small correction: the trial was 20 weeks, not 11. Does not change your point but people will quote it.

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