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c/insurancefights·submitted 17 days ago by u/adaeze_weiss

[Discussion] denial reason codes decoded, mostly fixable paperwork

Discussionbranch of 6 comments

Been lurking in c/glp1eu for about 7 months and finally have something worth posting. Short version: week 38, 1.7mg, and denial is the bit I still cannot get a straight answer on. I have read the wiki, I have read the last 15 threads, and the answers split roughly down the middle. What I actually want to know is…

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6 comments, started 17 days ago
u/ahmed_abubakar16 points·17 days ago

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/kian_ferreira13 points·16 days ago·edited

copay is separate from coverage

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u/bence_zielinski10 points·16 days ago

copay is separate from coverage

Yes, exactly this, and it is the bit that took me 77 weeks to accept.

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u/blunt_coldbox_notes8 points·15 days ago·edited

resubmission after denial requires new documentation

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u/elin_varga6 points·15 days ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/purity_pedantanalytical1 point·15 days ago

do not suggest misrepresenting a diagnosis, that is fraud

Yes, exactly this, and it is the bit that took me 21 weeks to accept.

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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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