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c/insurancefights·submitted 7 months ago by u/valeria_grimaldi

the denial question that gets asked weekly, answered properly

Discussionbranch of 8 comments

Genuinely asking, not being difficult. Everyone in c/labresults repeats that prior authorization is important. I believe it, but I have never seen anyone show why, and when I search I get 17 threads of people agreeing with each other. Is there a paper? Is there a measurement? Or is this one of those things that is…

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8 comments, started 7 months ago
u/adaeze_cabrera31 points·7 months ago

Copay was denial for the copay then another 6% of the total. Read the actual plan document.

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u/amara_haddad15 points·7 months ago

Which state? Coverage varies.

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u/hplc_hobbyistruns their own column4 points·7 months ago

redact member ids and group numbers from every screenshot

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u/tuva_aalto10 points·7 months ago

Did you get step therapy or outright denial?

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u/oskar_kaufmann12 points·7 months ago

step therapy documentation is the weapon, use it

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u/hamza_weiss4 points·7 months ago

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

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u/neha_rahimi10 points·7 months ago

appeal letter templates are in the wiki

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u/maren_sorensen5 points·7 months ago

appeal letter templates are in the wiki

Adding to this: external review is doing more work than the comment implies.

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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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