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Sourcing & reviews

Coverage update from today - here's what happened

Started by NSVQueen · · 24 replies · 285 views
#1

Called my insurance today about the prior auth and after being on hold forever, they finally confirmed the appeal went through and my coverage is approved going forward. Honestly I did a little happy dance because I'd been bracing for another denial after nearly 40 lbs down on this journey. Has anyone else dealt with a long appeals process like this, and did your copay stay stable after approval?

#2

Mine took almost three months and the copay did shift a bit once it went through, so brace for that. Curious whether yours came back at the same tier or got bumped

#4

Mine didn't budge at all after the appeal cleared, so maybe it varies by plan., but the copay holding steady is the one part of this I haven't had to worry about.

#5

My copay held steady for about six months then jumped maybe 30 bucks, so approval and price don't seem to move together. Did yours come through at the same tier you had before the appeal?

#6

Mine stayed flat for the first two fills after approval then jumped 25 bucks on the third, so I would not count on it holding. Worth calling back in a month to confirm the new number before it surprises you at pickup.

#8

Mine stayed flat for about six months after approval then jumped 25 bucks at the last refill, so stable was only temporary for me. Curious whether yours holds past the first couple cycles

#9

Curious whether your copay changed at all once the appeal cleared, since mine shifted a bit even after approval and I never got a straight answer on why

#13

My copay held steady for about two refills then crept up a bit, nothing dramatic though. Curious whether yours came with any paperwork explaining the change or just a new number at the counter

#14

Mine stayed flat for about two refills then inched up, so the approval email wasn't the last word on price. Worth checking the claim detail before you refill

#17

My copay came out the same on the other side of the appeal, no surprise bump. I keep a screenshot of the approval in my phone just in case billing gets cute later.

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