denial

The title is the argument: the step therapy thing finally clicked for me and I want to write it down. Here is the rest of it. New plan year, entirely new criteria, and…

why does nobody talk about copay, and I want the answer with the reasoning attached rather than just the conclusion. Kept a log with every date, name of department and…

The title is the argument: unpopular opinion: most of what gets said here about step therapy is guesswork. Here is the rest of it. New plan year, entirely new criteria,…

The title is the argument: approved after i sent them their own policy criteria back. Here is the rest of it. A denial letter is required to state a reason and to…

unpopular opinion: most of what gets said here about formulary is guesswork. Not a hot take, just something I have not seen said plainly here. Step therapy requires…

step therapy is doing more work than we give it credit for. Not a hot take, just something I have not seen said plainly here. Step therapy requires documented trial of…

the formulary advice in here is 3 years out of date. Making the case below, and I expect to lose some of it in the comments. Figures up front so nobody has to dig: 3…

the denial advice in here is 3 years out of date, and I am aware this is a minority view on this board. 3 years — those are the numbers, and they are the ones I am…

The title is the whole question — can we stop arguing about copay until somebody posts a number — but here is why I am asking. Prior authorisation criteria are…

Genuine question, and the title is the question: appeal — what am I missing here. Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting their…

four denials, three appeals, one external review, approved, which sounds obvious until you try to state the evidence for it. A denial letter is required to state a…

copay — 2 things I got wrong before I got it right — a position I have arrived at slowly and would like tested. Why step therapy denials feel unfair and are nonetheless…

reason code says "not medically necessary" at BMI 38. sure. Making the case below, and I expect to lose some of it in the comments. Documented eighteen months of what…

help me understand external review, I have read the wiki twice. Searched first, found three threads that contradict each other, hence the post. Step therapy requires…

my appeal letter, take it, it is free. I have gone back and forth on this for months. The process that has actually worked for people on this board, in order. Get the…

Question in the title, detail here: how much of what we believe about appeal actually comes from formulary threads. Prior authorisation criteria are republished each…

how do you actually verify external review. I am not trying to be the "source?" guy. I would just like a source. Internal appeals are decided by the plan. External…

The title is the argument: the prior authorization thing finally clicked for me and I want to write it down. Here is the rest of it. A denial letter is required to…

the three sentences that got my prior auth through, which sounds obvious until you try to state the evidence for it. A denial letter is required to state a reason and…

the external review advice in here is 2 years out of date, which sounds obvious until you try to state the evidence for it. Since the title puts numbers in the shop…