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c/insurancefights·submitted 19 days ago by u/RetaAndRegret2

[Win] HSA dollars changed the real cost by a third and i nearly missed it

Winbranch of 11 comments

Long-ish post, sorry. tl;dr at the bottom. I have been tracking external review against eGFR for 11 weeks because I could not find anyone who had. The correlation is weaker than I expected, which is itself mildly interesting given how confidently people link the two in here. Caveats up front: one person, one lab, one…

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11 comments, started 18 days ago
u/nadia_trevino15 points·18 days ago

Yeah, the denial code matters, it tells you what to fight.

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u/teodor_duarte5 points·18 days ago·edited

Titration speed is a side-effect dial far more than an efficacy dial.

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u/elin_varga6 points·18 days ago

appeal letter templates are in the wiki

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u/RetaAndRegret2OP3 points·17 days ago

External review overturned the denial. Took 12 weeks but the process exists.

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u/RetaAndRegret2OP8 points·17 days ago

External review overturned the denial. Took 7 weeks but the process exists.

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u/hedda_aguirre5 points·17 days ago

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

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u/nnt_nate2 points·17 days ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/oskar_kaufmann3 points·17 days ago

step therapy documentation is the weapon, use it

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u/ferran_dahlberg3 points·17 days ago·edited

This is correct. Appeal letters work.

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u/blunt_coldbox_notes1 point·17 days ago

say which country and which plan type

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[removed]6 points·17 days ago

[removed by moderator]

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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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