tried denial for 4 weeks. here is what happened.
I have had 21 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 4 days on nominally the same lane, which matters more in summer than in February.
The independent number came back 96.8% against a claimed 97.2%, which I read as agreement rather than a discrepancy — inter-lab variance on this assay is a point or two either way and treating one lab as ground truth is how people end up in pointless arguments with vendors.
Batch number is in the comments. Ask if you want the method.
best — the order this archive was captured in
Flair changed to match the content. Read the sidebar before posting next time and we are square.
External review overturned the denial. Took 24 weeks but the process exists.
Copay was copay for the copay then another 12% of the total. Read the actual plan document.
prior auth criteria are state-specific, prior authorization differs
step therapy documentation is the weapon, use it
prior auth criteria are state-specific, appeal differs
step therapy documentation is the weapon, use it
Adding to this: prior authorization is doing more work than the comment implies.
external review is the appeal after insurance says no
I love that this community will spend 40 comments on a detail. That pedantry is why the numbers here matter.
Which plan type? denial is different.
external review is the appeal after insurance says no
Yeah, the denial code matters, it tells you what to fight.
This is the "correlation is mechanism" thing again. You changed three variables at once.
Denied for prior auth, resubmitted with appeal documentation, approved on appeal. The criteria exist, you just have to meet them.
Which plan type? step therapy is different.
step therapy documentation is the weapon, use it
Respectfully this is a sample of one presented as a finding.
resubmission after denial requires new documentation
resubmission after denial requires new documentation
Yes, exactly this, and it is the bit that took me 40 weeks to accept.
Sweden plan: step therapy required 14 medications first. Did them all, got approval. The order matters.
redact member ids and group numbers from every screenshot
Strongly agree. Step therapy is predictable if you have the criteria.
step therapy documentation is the weapon, use it
You have restated the marketing copy. What is the actual substance here.
appeal letter templates are in the wiki
- 1Respectfully this is a sample of one presented as a finding.11 comments in this branch · started by u/ireland_drugs_pay
- 2Flair changed to match the content. Read the sidebar before posting next…8 comments in this branch · started by u/appeal_letter_al