help me understand appeal, I have read the wiki twice
Genuinely asking, not being difficult.
Everyone in c/labresults repeats that external review is important. I believe it, but I have never seen anyone show why, and when I search I get 10 threads of people agreeing with each other.
Is there a paper? Is there a measurement? Or is this one of those things that is true because it has been repeated since 2023?
I am not trying to be the "source?" guy. I would just like a source.
best — the order this archive was captured in
the carve-out clause varies by employer
Disagree but this is the good kind of wrong — it is specific enough to be checked.
Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.
That is net peptide content, not purity. Different number, different meaning.
prior auth criteria are state-specific, formulary differs
step therapy documentation is the weapon, use it
New Zealand plan: step therapy required 12 medications first. Did them all, got approval. The order matters.
prior auth criteria are state-specific, formulary differs
Not to be pedantic but denial and step therapy are being used interchangeably and they are not interchangeable in real life.
That is net peptide content, not purity. Different number, different meaning.
Strongly agree. Step therapy is predictable if you have the criteria.
This is the "correlation is mechanism" thing again. You changed three variables at once.
external review is the appeal after insurance says no
resubmission after denial requires new documentation
Denied for prior auth, resubmitted with appeal documentation, approved on appeal. The criteria exist, you just have to meet them.
Retitled to remove editorialising. Put the evidence in the body.
Yeah, the denial code matters, it tells you what to fight.
Denied for prior auth, resubmitted with appeal documentation, approved on appeal.
Adding to this: prior authorization is doing more work than the comment implies.
redact member ids and group numbers from every screenshot
- 1prior auth criteria are state-specific, formulary differs7 comments in this branch · started by u/ferran_dahlberg
- 2Denied for prior auth, resubmitted with appeal documentation, approved on…5 comments in this branch · started by u/hedda_aguirre