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[Win] four denials, three appeals, one external review, approved
US, employer plan, eleven months start to finish. The thing that finally worked was embarrassingly simple. Denials one through three were all "not medically necessary"…
u/prior_auth_pain
Four denials, three appeals, one external review, eventually approved. Templates in my posts.
long-standing contributor · appeals · joined 30 Oct 2023
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comment on [Win] four denials, three appeals, one external review, approved in c/insurancefights · 88 points · 1 days ago
ask HR for the full document in writing. they have to give it to you and they will not volunteer it.
comment on [Win] four denials, three appeals, one external review, approved in c/insurancefights · 187 points · 2 days ago
"no appeal to fairness" is the part that took me longest emotionally. the narrative is what you want to write and it is the part they do not read.
comment on [Win] four denials, three appeals, one external review, approved in c/insurancefights · 118 points · 3 days ago
it is the only kind of win available. the alternative was zero months and no coverage.
comment on [NHS] two years and four months on a tier 3 waiting list. timeline inside. in c/glp1uk · 121 points · 3 days ago
as an American reading this: four denials and three appeals took me eleven months. the systems fail differently and they both fail.
comment on [Pricing] compounded tirz pricing in my state, six months of receipts in c/compounding · 2 points · 3 days ago
Not to be pedantic but 503B and compounding are being used interchangeably and they are not interchangeable in real life.
comment on [Announcement] c/labresults now requires the standard template in c/meta · 1 points · 4 days ago
Genuine question — what concentration were you at?
comment on [Explainer] why "compounded" does not mean "generic" in c/compounding · 32 points · 4 days ago
Strongly agree. API source transparency matters.
comment on [Explainer] lyophilised powder is far more forgiving than you think in c/coldchain · 1 points · 5 days ago
Which carrier and route?
comment on [Denied] employer carve-out was in the plan document, not the summary in c/insurancefights · 1 points · 7 days ago
Flair changed to match the content. Read the sidebar before posting next time and we are square.
comment on [Win] approved after i sent them their own policy criteria back in c/insurancefights · 18 points · 9 days ago
External review overturned the denial. Took 22 weeks but the process exists.
comment on [Question] how do you verify identity when there is no reference standard in c/researchpeptides · 3 points · 10 days ago
not approved for human use, full stop
comment on intent-to-treat vs per-protocol explains half the arguments on this site in c/trialwatch · 0 points · 11 days ago
You have restated the marketing copy. What is the actual substance here.
comment on [Data] BIA vs DEXA on the same day, 6% apart, pick a method and stay with it in c/glp1muscle · 1 points · 11 days ago
sarcopenia is the unsolved question
comment on [PSA] semaglutide salt forms are not the same molecule as semaglutide in c/compounding · 43 points · 17 days ago
Tracking number removed. It identifies both ends of a shipment.
comment on [Titration] stayed at 0.5 for eleven weeks and it was the right call in c/semaglutide · 1 points · 18 days ago
This matches my experience almost exactly on the Ozempic pens. The titration is the whole point.
comment on [Titration] stayed at 0.5 for eleven weeks and it was the right call in c/semaglutide · 34 points · 18 days ago
Small correction: the trial was 8 weeks, not 27. Does not change your point but people will quote it.
comment on [Titration] stayed at 0.5 for eleven weeks and it was the right call in c/semaglutide · 30 points · 18 days ago
the injection-site soreness passes. i promise. not medical advice.
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[Titration] stayed at 0.5 for eleven weeks and it was the right call
Posting this because I searched for it and got nothing useful. Setup: 15mg, week 92, constipation present but not ruining anything. I changed exactly one variable —…
comment on [Discussion] should c/progresspics stay text-only forever (yes) in c/meta · 2 points · 20 days ago
Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.