Found a vendor with insanely cheap prices - too good to be true? — need advice

Dr.PathRoch 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.

PedsEndoPhilly said:

Agreed, with a caveat about community reputation: it is a lagging indicator.

This answered a question I did not know how to ask.

Dr.PathRoch said:

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

I read this differently from Dr.PathRoch, 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.

One concrete data point for the thread. Keep the original post as written when you update it, and add the correction underneath. An edited-away mistake is invisible to the next person who makes it.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful. No action needed from anybody.