TrialTracker_MD 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.
LeilaHI said:Right, and one flattering data point from a group buy is not consistency.
That reframing is the part I needed. I will report back once I have actually tried it.
TrialTracker_MD said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.
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View ResultsThe figures, for anyone assembling their own picture. For anyone reading later: the numbers in this thread are worth checking against a primary source before you act on them, including mine. Half the figures circulating in this community trace back to a secondary summary that dropped a qualifier.