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c/insurancefights·posted 7 months ago by u/whois_wanda

switched from 7.5mg to 15mg and the sulphur burps got better, not worse

Question

Long-ish post, sorry. tl;dr at the bottom.

I have been tracking prior authorization against ApoB for 37 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 assay, no control, and I changed my training in the middle of it, which was stupid.

tl;dr: probably real, definitely smaller than the threads imply, and not worth reorganising your week around.

352 up / 102 down78% upvoted17 commentsid by06h828 Dec 2025

17 comments

16 in this archive, depth 5

best — the order this archive was captured in

u/nadia_trevino48 points·7 months ago·edited

No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.

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u/formulary_fighterappeals36 points·7 months ago

step therapy documentation is the weapon, use it

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u/amira_dumitru12 points·7 months ago

redact member ids and group numbers from every screenshot

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u/line_petrov20 points·7 months ago

The evidence standard in c/vendorvetting gets called too strict about once a month, and every time, the thread ends with the complainant agreeing.

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u/kian_balogun16 points·7 months ago

Disagree but this is the good kind of wrong — it is specific enough to be checked.

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u/whois_wandaOP12 points·7 months ago

copay is separate from coverage

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u/purity_pedantanalytical8 points·7 months ago

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

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u/rekha_mbeki11 points·7 months ago
ask your actual doctor, not us
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u/dose_diary_danalog keeper11 points·7 months ago

prior auth criteria are state-specific, step therapy differs

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u/formulary_fighterMOD6 points·7 months ago

Tracking number removed. It identifies both ends of a shipment.

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u/kasper_cabrera6 points·7 months ago

Not convinced. The evidence does not support that reading.

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u/prior_auth_painappeals2 points·7 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/plain_titration3 points·7 months ago

appeal letter templates are in the wiki

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u/adaeze_weiss1 point·7 months ago

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

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u/appeal_letter_al1 point·7 months ago

formulary exclusions are negotiable sometimes

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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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c/insurancefights rules
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  2. Redact member ids and group numbers from every screenshot.
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