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c/insurancefights·posted 1 months ago by u/curious_panel_only

what would you tell week-1 you about external review

Template

Something I noticed reading old threads that I have not seen said out loud.

The advice on appeal 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 the same confidence.

I have listed what I think the current consensus is below. Correct me — that is the point of posting it.

0 up / 0 down41% upvoted9 commentsid beiy6x23 Jun 2026

9 comments

9 in this archive, depth 4

best — the order this archive was captured in

u/nikhil_asante4 points·1 months ago

Strongly agree. Step therapy is predictable if you have the criteria.

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u/coring_the_stopper3 points·1 months ago

Strongly agree.

Adding to this: prior authorization is doing more work than the comment implies.

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u/canada_coverage1 point·1 months ago

appeal letter templates are in the wiki

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u/greta_chukwu1 point·1 months ago

copay is separate from coverage

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u/sock_puppet_spotter2 points·1 months ago

say which country and which plan type

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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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