prior authorization

Genuine question, and the title is the question: how do you actually verify formulary. Documented eighteen months of what had been tried in a one-page table. That table…

three years of denial threads, summarised so you do not have to read them. It is the sort of thing everyone half-believes and nobody writes down. Asked for the policy…

unpopular opinion: most of what gets said here about appeal is guesswork. Not a hot take, just something I have not seen said plainly here. External review was the…

the UK — has anyone got a straight answer on formulary, and I want the answer with the reasoning attached rather than just the conclusion. Kept a log with every date,…

the appeal advice in here is 3 years out of date. It is the sort of thing everyone half-believes and nobody writes down. The numbers the title promised, since a…

The title is the argument: three years of prior authorization threads, summarised so you do not have to read them. Here is the rest of it. Prior authorisation criteria…

Question in the title, detail here: how much of what we believe about prior authorization actually comes from appeal threads. A denial letter is required to state a…

three years of step therapy threads, summarised so you do not have to read them. It is the sort of thing everyone half-believes and nobody writes down. External review…

prior authorization — 22 things I got wrong before I got it right, and I am aware this is a minority view on this board. Kept a log with every date, name of department…

does external review actually matter or is it forum lore at this point — that is what I am asking, and I have already read the wiki twice. Peer-to-peer took fifteen…

we are measuring appeal at the wrong time and calling it noise — a position I have arrived at slowly and would like tested. Employer-sponsored plans may be regulated…

the formulary thing finally clicked for me and I want to write it down, which sounds obvious until you try to state the evidence for it. A denial letter is required to…

the step therapy rule is doing its job and people should stop complaining — posting the reasoning in public because a policy you cannot inspect is just a preference.…

Genuine question, and the title is the question: how do you actually verify copay. Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting…

someone explain prior authorization to me like I have not read a paper in years. I would rather ask a basic question now than get this wrong quietly for two months.…

help me understand denial, I have read the wiki twice. I would rather ask a basic question now than get this wrong quietly for two months. Asked for the policy bulletin…

the appeal thing finally clicked for me and I want to write it down. Not a hot take, just something I have not seen said plainly here. Step therapy requires documented…

Question in the title, detail here: help me understand formulary, I have read the wiki twice. Prior authorisation criteria are republished each plan year. A criterion…

The title is the argument: appeal — 22 things I got wrong before I got it right. Here is the rest of it. Prior authorisation criteria are republished each plan year. A…

external review is doing more work than we give it credit for, and I am aware this is a minority view on this board. Kept a log with every date, name of department and…

The title is the whole question — does appeal actually matter or is it forum lore at this point — but here is why I am asking. A denial letter is required to state a…

unpopular opinion: most of what gets said here about external review is guesswork. Making the case below, and I expect to lose some of it in the comments. Appeal…

peer-to-peer review: what to say and what to bring. Short post, long comment section, probably. New plan year, entirely new criteria, and the denial that had been…

reading formulary threads from 2024 and half of it aged badly. Making the case below, and I expect to lose some of it in the comments. Spent six weeks arguing in…

why does nobody talk about prior authorization. Searched first, found three threads that contradict each other, hence the post. External review was the thing that…