roxy_nash 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.
Correct me if the detail matters more than I have assumed.
rachel_ABQ 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. Sending this to two other people who asked me the same thing last week.
roxy_nash 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.
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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.
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.