Dr.NateNeph 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.
chris_chi24 said:Agreed, with a caveat about community reputation: it is a lagging indicator.
Thank you — that is the clearest version of this I have read, and I have read a lot of them. Adding it to my notes with a link back to this thread.
Dr.NateNeph said:Denials are usually procedural rather than clinical, and the order that works reflects that.
I read this differently from Dr.NateNeph, 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.
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View ResultsAdding the numbers, since they settle part of this. 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.
Happy to go further on any of that.
Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Report rather than reply if it drifts again.