Dr.NephBHM_UK 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.

mark_tokyo said:

Right, and one flattering data point from a group buy is not consistency.

Bookmarking. The distinction being drawn above is the one nobody else makes.

Dr.NephBHM_UK said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

This is where I part company with the consensus forming above. 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.

The figures, for anyone assembling their own picture. Say what you would expect to see if you were wrong, before you look. It is a small discipline and it changes what you notice.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful. Carry on.