c/insurancefights — hot, page 4

the copay advice in here is 2 years out of date. Change my mind, genuinely — I have no stake in being right about this. The numbers the title promised, since a headline…

Trying to get a straight answer on this: Spain — has anyone got a straight answer on denial. Employer-sponsored plans may be regulated differently from individually…

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.…

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…

Spain: copay, and what it actually costs here. Not a hot take, just something I have not seen said plainly here. External review was the thing that finally worked. I…

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

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…

Slightly embarrassed to be asking this, but: someone explain external review to me like I have not read a paper in years. Documented eighteen months of what had been…

The title is the argument: we are measuring external review at the wrong time and calling it noise. Here is the rest of it. Prior authorisation criteria are republished…

step therapy — what am I missing here. Searched first, found three threads that contradict each other, hence the post. Asked for the policy bulletin by number and wrote…

reading denial threads from 2024 and half of it aged badly — a position I have arrived at slowly and would like tested. Missed a deadline because I counted from when I…

does formulary 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 minutes…

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…

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…

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…

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…

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 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…

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…

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…