[Meta] the appeal rule is doing its job and people should stop complaining
Right, the denial question again, but with numbers this time.
I have 5 data points over 16 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign.
The thing I would flag for anyone new: the effect I am describing showed up at week 77, not week 31. People give up long before the interesting part.
Interested in whether this matches other people's logs or whether I am an outlier.
best — the order this archive was captured in
Australia plan: step therapy required 18 medications first. Did them all, got approval. The order matters.
appeal letter templates are in the wiki
the UK plan: step therapy required 17 medications first. Did them all, got approval. The order matters.
formulary exclusions are negotiable sometimes
Copay was appeal for the copay then another 7% of the total. Read the actual plan document.
Strongly agree. Step therapy is predictable if you have the criteria.
This is correct. Appeal letters work.
say which country and which plan type
say which country and which plan type
Disagree on that part. 93.7% and 99.3% on the same vial is normal.
Slight fix: the number was 99.0, not 98.9. Decimal point, but a fairly consequential one.
copay is separate from coverage
Poland plan: step therapy required 8 medications first. Did them all, got approval. The order matters.
This is an urgent-care question wearing a forum question's clothes. Please contact a clinician rather than waiting for replies.
external review is the appeal after insurance says no
You have restated the marketing copy. What is the actual substance here.
say which country and which plan type
say which country and which plan type
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
say which country and which plan type Counter-anecdote: opposite result, same dose.
Disagree on that part. 95.1% and 99.3% on the same vial is normal.
Not to be pedantic but prior authorization and external review are being used interchangeably and they are not interchangeable in real life.
- 1Australia plan: step therapy required 18 medications first. Did them all,…6 comments in this branch · started by u/ilias_cabrera
- 2This is correct. Appeal letters work.6 comments in this branch · started by u/cato_achebe