2.1k
the denial question that gets asked weekly, answered properly
Genuinely asking, not being difficult. Everyone in c/labresults repeats that prior authorization is important. I believe it, but I have never seen anyone show why, and…
u/valeria_grimaldi
Contributes reviews on supplier material. Based in Kumasi.
member · joined 17 Aug 2025
2,489post karma
930comment karma
2submissions
18comments
comment on [Denied] reason code says "not medically necessary" at BMI 38. sure. in c/insurancefights · 1 points · 3 days ago
Did you get step therapy or outright denial?
comment on [Question] does the copay card stack with anything or is that a myth in c/insurancefights · 19 points · 11 days ago
formulary exclusions are negotiable sometimes
comment on [Discussion] denial reason codes decoded, mostly fixable paperwork in c/insurancefights · 3 points · 16 days ago
What was the denial code?
comment on unpopular opinion: step therapy is massively overrated in c/insurancefights · 6 points · 1 months ago
No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.
comment on formulary is the most under-discussed thing in c/coldchain in c/insurancefights · 1 points · 3 months ago
appeal letter templates are in the wiki
comment on the step therapy question that gets asked weekly, answered properly in c/insurancefights · 7 points · 5 months ago
Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.
comment on [Results] 7 weeks, 41kg, and formulary was the hard part in c/insurancefights · 5 points · 5 months ago
Which plan type? copay is different.
comment on the denial question that gets asked weekly, answered properly in c/insurancefights · 52 points · 7 months ago
Poland plan: step therapy required 6 medications first. Did them all, got approval. The order matters.
comment on the denial question that gets asked weekly, answered properly in c/insurancefights · 113 points · 7 months ago
Denied for prior auth, resubmitted with step therapy documentation, approved on appeal. The criteria exist, you just have to meet them.
comment on the denial question that gets asked weekly, answered properly in c/insurancefights · 15 points · 7 months ago
formulary exclusions are negotiable sometimes
comment on someone explain appeal to me like I have not read a paper in years in c/insurancefights · 136 points · 9 months ago
Sweden plan: step therapy required 8 medications first. Did them all, got approval. The order matters.
comment on copay — 3 things I got wrong before I got it right in c/insurancefights · 49 points · 10 months ago
Yeah, the denial code matters, it tells you what to fight.
comment on genuine question about denial that I am slightly embarrassed to ask in c/insurancefights · 23 points · 1 year ago
This is the "correlation is mechanism" thing again. You changed three variables at once.
comment on [Results] 17 weeks, 36kg, and denial was the hard part in c/insurancefights · 1 points · 1 year ago
external review is the appeal after insurance says no
comment on prior authorization — 9 things I got wrong before I got it right in c/insurancefights · 34 points · 1 year ago
Which state? Coverage varies.
comment on tried appeal for 14 weeks. here is what happened. in c/insurancefights · 254 points · 1 year ago
Which state? Coverage varies.
comment on 14 months in and formulary is still the thing I get wrong in c/insurancefights · 20 points · 1 year ago
That is net peptide content, not purity. Different number, different meaning.
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14 months in and formulary is still the thing I get wrong
Posting this because I searched for it and got nothing useful. Setup: 7.5mg, week 24, sulphur burps present but not ruining anything. I changed exactly one variable —…
comment on switched from 15mg to 1.0mg and the reflux got better, not worse in c/insurancefights · 34 points · 2 years ago
Not convinced. The evidence does not support that reading.