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c/insurancefights·posted 2 years ago by u/ismael_nwosu

[Discussion] step therapy is doing more work than we give it credit for

Discussion Receipts ×3 Cold Box ×1 Long Haul ×1

Week 10 update. 15kg down from the start, constipation basically gone since about week 50.

Things that worked: consistency, protein at breakfast, walking more than I want to. Things that did not: everything I bought on the internet to help with constipation.

The part that surprised me is how much of this is admin. Ordering, storing, logging, remembering. Nobody mentions that the hard bit is not the drug, it is the routine.

Happy to answer anything. Please do not ask me what dose you should be on.

4,401 up / 520 down89% upvoted20 commentsid eh2ux721 Jun 2024

20 comments

6 in this archive, depth 2

best — the order this archive was captured in

u/jarno_adeyemi617 points·2 years ago

Which plan type? formulary is different.

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u/liv_vukovic383 points·2 years ago

Copay was copay for the copay then another 10% of the total. Read the actual plan document.

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u/vito_beaulieu552 points·2 years ago

resubmission after denial requires new documentation

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u/RetaAndRegret2182 points·2 years ago

Copay was copay for the copay then another 10% of the total.

Disagree on that part. 98.1% and 98.9% on the same vial is normal.

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u/ferran_dahlberg285 points·2 years ago

prior auth criteria are state-specific, formulary differs

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u/hedda_aguirre147 points·2 years ago·edited

denial reason codes matter, ask for the actual code

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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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