u/maren_ibarra

a peer-to-peer call is often faster than a written appeal

Cosigning on external review. It is a real mechanism, it is underused, and the deadlines are strict.

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

Tracked grip strength and three lifts monthly. Cheaper than scanning and directionally the same answer.

employer plans and individual plans are different fights

Right — the non-scale victories are the ones I remember. The numbers all blur together after a while.

Is this the first time, or a pattern you can see now?

Disagree that the pace matters as much as you think. Durable is better than fast and nobody posts about durable.

Not convinced. That is a formulary exclusion rather than a prior authorisation denial, and the route to challenge it is different.

Gently disagree with the framing — that is not a plateau, that is a month. They are different things.

Nobody noticed for months. Then several people noticed in the same fortnight, which was strange and quite nice.

Employer-sponsored plans may be regulated differently from individually purchased ones, which changes both the appeal route and which regulator hears a complaint.

Internal appeals are decided by the plan. External review is decided by an independent body and, where it applies, its determination is binding. They are separate mechanisms and the second is chronically underused.

The boring middle lasted the longest and it is the part I am most proud of.

Stopped reading the fastest posts here for a month and my mood improved considerably.

32kg over 11 months and honestly the most useful marker was that stairs stopped being a decision.

Correction: 6kg over 8 months is a different claim from 6kg in a month, and the post reads as the second.

DEXA has a real error margin and people quote it to one decimal

Fat-free mass index is a ratio of fat-free mass to height squared. It moves when either term does, which makes it awkward to interpret during active weight change.

the formulary is published, read it before you appeal

Careful — the deadline runs from the date on the letter. Waiting for a call back can cost you the appeal entirely.

Disagree with the tone strategy. Anger has never moved a determination; matching the criterion has.

Prior authorisation criteria are republished each plan year. A criterion that blocked you in one year may not exist in the next, so a denial is worth retesting after the turnover.

document what has been tried and for how long, that is the whole case