u/maren_ibarra

resubmission after denial requires new documentation

Yes, exactly this, and it is the bit that took me 40 weeks to accept.

Copay was copay for the copay then another 12% of the total. Read the actual plan document.

step therapy documentation is the weapon, use it

This is the "correlation is mechanism" thing again. You changed three variables at once.

Which plan type? external review is different.

external review is the appeal after insurance says no

Slight fix: the number was 99.3, not 93.7. Decimal point, but a fairly consequential one.

text only is the whole point of the community

Stalled for 22 weeks, changed nothing, and it started moving again on week 41.

Yeah, text-only removes the comparison.

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

external review is the appeal after insurance says no

Small correction: the trial was 11 weeks, not 24. Does not change your point but people will quote it.

Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.

formulary exclusions are negotiable sometimes

appeal letter templates are in the wiki

Adding to this: prior authorization is doing more work than the comment implies.

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