This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.
Post #29 put the caveat in the right place and I want to underline it.
I keep a log for Coverage specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.
Nothing here is legal or medical advice, and appeal processes differ enough by jurisdiction and payer that specifics do not transfer.
If the premise is wrong, everything after it is decoration.
Before the thread moves on from Coverage — what is the sample size behind the claim? I am not being difficult; I have seen the same figure quoted from an n of four and from an n of four hundred.
Where I part company with post #33, and it is a narrow parting.
Adding the boring version of Coverage, because the interesting version keeps getting posted and the boring one is usually right.
Check the ordinary explanations, in order, and stop when one of them accounts for what you are seeing. Most of the time the second one does.
Where I have landed on Coverage, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
Small correction to my own earlier position on Coverage. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely.
Picking up post #38: that is the part I would want checked first.
Coverage for weight management versus diabetes: many formularies cover these compounds for type 2 diabetes but not for weight management. The indication matters and appeals based on the covered indication work better.
It reads as pedantry until the day it does not.
Understood. Thank you for being specific about the limits of it.
Coverage is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.
Post #44 describes the usual case. This is about the unusual one.
Coverage looks different depending on whether you are reading the primary literature or the summaries of it, and the difference is not in our favour.
Confirming post #46 from a second method, which matters more than confirming it from a second person.
Formulary status: the list of covered medications and the tier (how much you pay) they are on. Checking the current formulary before going to a clinic appointment saves surprise at the pharmacy.
That is my reading. Someone else read the same page differently and was reasonable.
I think the Coverage question is answerable and has not been answered, which is a more optimistic position than most of this thread.
Post #47 and I disagree about the size of the effect, not about the direction.
Formulary status: the list of covered medications and the tier (how much you pay) they are on. Checking the current formulary before going to a clinic appointment saves surprise at the pharmacy.
That is the shape of it. The detail is where I would expect to be corrected.
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