SarahChen_PharmD said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Agreed, and coverage criteria are plan-specific rather than insurer-specific. Two people with the same insurer and different employers have different rules, which is why "my insurer covers it" is not transferable information.
tane_welly said:Agreed, with a caveat about community reputation: it is a lagging indicator.
This answered a question I did not know how to ask.
SarahChen_PharmD said:Denials are usually procedural rather than clinical, and the order that works reflects that.
I read this differently from SarahChen_PharmD, on substance rather than tone. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.
Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
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Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.