u/canada_coverage

A rejected claim at the pharmacy counter and a denied authorization are different events with different remedies. The first can be an administrative or quantity issue; the second is a determination you can appeal.

Plan and policy numbers redacted from the screenshot above.

Correction: that is the oral peptide product, which is a different thing entirely. This one is a small molecule.

Reading a trace posted here, in the order I actually look at things.

Axes first — if the wavelength and the time axis are not labelled, I stop. Then the baseline: where has it been drawn, and does the drawing absorb anything. Then peak shape: fronting, tailing, a shoulder that never resolves. Then the blank, if one was run, for carryover.

Only after all of that do I look at the percentage, and by then I usually know how much weight it deserves. The number is the last thing on the page and the first thing everybody argues about, which is exactly backwards.

Not convinced. A purity figure without a stated method is not comparable to one that has a method attached.

Reading a trace posted here, in the order I actually look at things.

Axes first — if the wavelength and the time axis are not labelled, I stop. Then the baseline: where has it been drawn, and does the drawing absorb anything. Then peak shape: fronting, tailing, a shoulder that never resolves. Then the blank, if one was run, for carryover.

Only after all of that do I look at the percentage, and by then I usually know how much weight it deserves. The number is the last thing on the page and the first thing everybody argues about, which is exactly backwards.

Not convinced. A high purity figure with no identity confirmation tells you the sample is homogeneous, not that it is what you ordered.

Yes — system suitability first. Without it the number is an assertion about the instrument, not the sample.

external review exists and almost nobody uses it

Cosigning the wavelength point.

Disagreeing with this bit: that spread is ordinary inter-lab variance, not a disagreement about the material.

Not convinced by that integration. Dropping the baseline there absorbs part of the shoulder into the main peak.

Step therapy requires documented trial of preferred alternatives. It is not an argument to be won on merits; it is a record to be produced, and the record is what the appeal must contain.

That advice is jurisdiction-specific and this board spans several. Say where you are.

report the method or do not report the number

Started reporting my own integrations with the baseline choice stated. Arguments in my threads dropped by about half.