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Single comment threadYou are looking at one branch of tried denial for 4 weeks. here is what happened. — 51 comments in the full submission. View in context.
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c/insurancefights·submitted 1 year ago by u/maren_ibarra

tried denial for 4 weeks. here is what happened.

Questionbranch of 11 comments

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…

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This branch

11 comments, started 1 year ago
u/ireland_drugs_pay20 points·1 year ago

Respectfully this is a sample of one presented as a finding.

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u/janoshik_junkieindependent tester27 points·1 year ago

resubmission after denial requires new documentation

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u/maren_ibarraOP14 points·1 year ago

resubmission after denial requires new documentation

Yes, exactly this, and it is the bit that took me 40 weeks to accept.

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u/maren_ibarraOP9 points·1 year ago

Sweden plan: step therapy required 14 medications first. Did them all, got approval. The order matters.

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u/bence_zielinski8 points·1 year ago

redact member ids and group numbers from every screenshot

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u/saskia_lokken20 points·1 year ago

Which state? Coverage varies.

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u/bence_zielinski5 points·1 year ago

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

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u/karim_restrepo3 points·1 year ago

step therapy documentation is the weapon, use it

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u/tomas_lehtinen13 points·1 year ago

You have restated the marketing copy. What is the actual substance here.

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u/ilias_cabrera10 points·1 year ago·edited

appeal letter templates are in the wiki

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u/cato_achebe6 points·1 year ago

the carve-out clause varies by employer

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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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