Are insured members able to see clinical criteria for prior authorization required drugs?

If you have a medication on your formulary but it requires PA, is the pt able to see the clinical criteria used to determine approval?

In the past I thought an individual reviewed it with their "medical judgement" but my understanding now is there is written clinical guidelines used.

Are pts able (and more importantly, legally entitled) to see this prior to submitting a PA (or receiving a denial)? The PA process takes time with back and forth and it would be nice to have the clinical information available when visiting with the prescribing physician so they can articulate the reasoning having known the clinical criteria.

Or do provider portals for the big PBM have it available for review when a provider submits a PA, just not visible for insured members?

reddit.com
u/Marvel5123 — 1 day ago

Are insured members able to see clinical criteria for prior authorization required drugs?

If you have a medication on your formulary but it requires PA, is the pt able to see the clinical criteria used to determine approval?

In the past I thought an individual reviewed it with their "medical judgement" but my understanding now is there is written clinical guidelines used.

Are pts able (and more importantly, legally entitled) to see this prior to submitting a PA (or receiving a denial)? The PA process takes time with back and forth and it would be nice to have the clinical information available when visiting with the prescribing physician so they can articulate the reasoning having known the clinical criteria.

Or do provider portals for the big PBM have it available for review when a provider submits a PA, just not visible for insured members?

reddit.com
u/Marvel5123 — 1 day ago
▲ 12 r/texas

Did Texas DMV reinstate the "Classic Online Renewal" for vehicle registration instead of TxT?

https://preview.redd.it/9b2xez2ncujh1.png?width=1052&format=png&auto=webp&s=02ee46e780286d0941a5d0838ccf6d24247bc40c

When I tried to do our vehicle registration recently the "classic option" (screenshot above) said it was no longer supported and individuals were required to use Texas by Texas (TxT).

Tried again today and saw the "classic online renewal" (no account registration/login required) appears once again working and an option (accepted payment).

Did DMV re-instate this option after it was disabled? Just want to make sure it will process through...

reddit.com
u/Marvel5123 — 4 days ago
▲ 1 r/Dallas

Bathroom remodeling contractor recommendations (especially those with ADA-compliant construction experience)

Looking for bathroom remodeling contractor recommendations, especially those who are experienced with ADA compliant shower design/install. Thank you!

reddit.com
u/Marvel5123 — 8 days ago

Is it better to "top off" LXT/XGT batteries when they're down to two or three bars or wait until they're down to one (or one flashing) bar?

Makita - After using OPE, will have batteries that are 2 or 3 bars. Is it better to top them off now or wait until they are near discharge? Does topping off count as a "cycle" that reduces longevity or far better than running to low/near empty?

reddit.com
u/Marvel5123 — 10 days ago
▲ 13 r/Makita

Is it better to "top off" LXT/XGT batteries when they're down to two or three bars or wait until they're down to one (or one flashing) bar?

After using OPE, will have batteries that are 2 or 3 bars. Is it better to top them off now or wait until they are near discharge? Does topping off count as a "cycle" that reduces longevity or far better than running to low/near empty?

reddit.com
u/Marvel5123 — 10 days ago

$300k in 401(k). 32 years old. A 'financial advisor friend' helped me allocate my portfolio. YTD return 12.19%. I think I should rebalance however and looking for advice (100% VINIX)?

32 years old, have $300k in a traditional 401(k). I am contributing max to get employer match. I am able to withdraw before 59.5 w/o penalty (SECURE 2.0 Act exception). I have never really understood 401(k) investing and either used robot advisors (which I know now have stupid high fees). A couple years ago, a 'financial advisor friend' rebalanced my portfolio to this:

----

T Rowe Price Small-Cap Stock - 26.76%

Fidelity Blue Chip Growth K6 - 26.14%

Vanguard International Growth Admiral - 25.26%

JP Morgan Large Cap Growth R4 - 12.77%

MFS Mid-Cap Growth Fund R6 - 6.05%

Loomis Sayles Small Cap Growth Instl - 3.02%

----

A quick AI search made it seem like my positions are not all that great and somewhat risky with high fees. I learned recently about "VOO and chill" which I started doing instead of individual stocks and never realized that such a "simple" investment choice was so highly regarded and it made me look at my 401(k) and wonder if I should rebalance. Is going to 100% VINIX a good option here?

I also am in a pension with strong benefits coming. At age 39, I should have about a $60k/yr pension for life and at age 43, about $100k/yr. With this "safety net", is it worth exploring a more aggressive growth strategy than just, for example, 100% VINIX? I do want to FI/RE.

---

These are the plan's choices:

T Rowe Price Small-Cap Stock (OTCFX)

Fidelity Blue Chip Growth K6 (FBCGX)

Vanguard International Growth Admiral (VWILX)

JP Morgan Large Cap Growth R4 (JLGQX)

MFS Mid-Cap Growth Fund R6 (OTCKX)

Loomis Sayles Small Cap Growth Instl (LSSIX)

Cohen & Steers Instl Realty Shares (CSRIX)

DFA US Large Cap Value Portfolio Instl (DFLVX)

JP Morgan Mid Cap Value R6 (JMVYX)

MissionSquare PLUS Fund R10

Sterling Capital Total Return Bond (BIBTX)

Vanguard Developed Markets Index Instl (VTMNX)

Vanguard Institutional Index Instl (VINIX) --- is this the winner here?

Vanguard Morningstar Small-Cap Idx ADM (VSMAX)

Vanguard Total Bond Market Index Instl (VBTIX)

Vanguard Treasury Money Market Fund (VUSXX)

American Funds 2010 Trgt Date Ret Inc R6 (RFTTX)

American Funds 2015 Trgt Date Ret Inc R6 (RFJTX)

American Funds 2020 Trgt Date Ret Inc R6 (RRCTX)

*American Funds 2025 Trgt Date Ret Inc R6 (*RFDTX)

American Funds 2030 Target Date Ret R6 (RFETX)

American Funds 2035 Target Date Ret R6 (RFFTX)

American Funds 2040 Target Date Ret R6 (RFGTX)

American Funds 2045 Target Date Ret R6 (RFHTX)

American Funds 2050 Target Date Ret R6 (RFITX)

American Funds 2055 Target Date Ret R6 (RFKTX)

American Funds 2060 Target Date Ret R6 (RFUTX)

reddit.com
u/Marvel5123 — 10 days ago

Looking for 401(k) allocation advice. Several hundred thousand in account, YTD 12.19% but I think the "financial advisor friend" advice on allocations is a bit off...

32 years old, have $300k in a traditional 401(k). I am contributing max to get employer match. I am able to withdraw before 59.5 w/o penalty (SECURE 2.0 Act exception). I have never really understood 401(k) investing and either used robot advisors (which I know now have stupid high fees). A couple years ago, a 'financial advisor friend' rebalanced my portfolio to this:

----

T Rowe Price Small-Cap Stock - 26.76%

Fidelity Blue Chip Growth K6 - 26.14%

Vanguard International Growth Admiral - 25.26%

JP Morgan Large Cap Growth R4 - 12.77%

MFS Mid-Cap Growth Fund R6 - 6.05%

Loomis Sayles Small Cap Growth Instl - 3.02%

----

A quick AI search made it seem like my positions are not all that great and somewhat risky with high fees. I learned recently about "VOO and chill" which I started doing instead of individual stocks and never realized that such a "simple" investment choice was so highly regarded and it made me look at my 401(k) and wonder if I should rebalance. Is going to 100% VINIX a good option here?

I also am in a pension with strong benefits coming. At age 39, I should have about a $60k/yr pension for life and at age 43, about $100k/yr. With this "safety net", is it worth exploring a more aggressive growth strategy than just, for example, 100% VINIX? I do want to FI/RE.

---

These are the plan's choices:

T Rowe Price Small-Cap Stock (OTCFX)

Fidelity Blue Chip Growth K6 (FBCGX)

Vanguard International Growth Admiral (VWILX)

JP Morgan Large Cap Growth R4 (JLGQX)

MFS Mid-Cap Growth Fund R6 (OTCKX)

Loomis Sayles Small Cap Growth Instl (LSSIX)

Cohen & Steers Instl Realty Shares (CSRIX)

DFA US Large Cap Value Portfolio Instl (DFLVX)

JP Morgan Mid Cap Value R6 (JMVYX)

MissionSquare PLUS Fund R10

Sterling Capital Total Return Bond (BIBTX)

Vanguard Developed Markets Index Instl (VTMNX)

Vanguard Institutional Index Instl (VINIX) --- is this the winner here?

Vanguard Morningstar Small-Cap Idx ADM (VSMAX)

Vanguard Total Bond Market Index Instl (VBTIX)

Vanguard Treasury Money Market Fund (VUSXX)

American Funds 2010 Trgt Date Ret Inc R6 (RFTTX)

American Funds 2015 Trgt Date Ret Inc R6 (RFJTX)

American Funds 2020 Trgt Date Ret Inc R6 (RRCTX)

*American Funds 2025 Trgt Date Ret Inc R6 (*RFDTX)

American Funds 2030 Target Date Ret R6 (RFETX)

American Funds 2035 Target Date Ret R6 (RFFTX)

American Funds 2040 Target Date Ret R6 (RFGTX)

American Funds 2045 Target Date Ret R6 (RFHTX)

American Funds 2050 Target Date Ret R6 (RFITX)

American Funds 2055 Target Date Ret R6 (RFKTX)

American Funds 2060 Target Date Ret R6 (RFUTX)

reddit.com
u/Marvel5123 — 10 days ago

$300k in 401(k). 32 years old. A 'financial advisor friend' helped me allocate my portfolio. YTD return 12.19%. I think I should rebalance however and looking for advice (100% VINIX)?

32 years old, have $300k in a traditional 401(k). I am contributing max to get employer match. I am able to withdraw before 59.5 w/o penalty (SECURE 2.0 Act exception). I have never really understood 401(k) investing and either used robot advisors (which I know now have stupid high fees). A couple years ago, a 'financial advisor friend' rebalanced my portfolio to this:

----

T Rowe Price Small-Cap Stock - 26.76%

Fidelity Blue Chip Growth K6 - 26.14%

Vanguard International Growth Admiral - 25.26%

JP Morgan Large Cap Growth R4 - 12.77%

MFS Mid-Cap Growth Fund R6 - 6.05%

Loomis Sayles Small Cap Growth Instl - 3.02%

----

A quick AI search made it seem like my positions are not all that great and somewhat risky with high fees. I learned recently about "VOO and chill" which I started doing instead of individual stocks and never realized that such a "simple" investment choice was so highly regarded and it made me look at my 401(k) and wonder if I should rebalance. Is going to 100% VINIX a good option here?

I also am in a pension with strong benefits coming. At age 39, I should have about a $60k/yr pension for life and at age 43, about $100k/yr. With this "safety net", is it worth exploring a more aggressive growth strategy than just, for example, 100% VINIX? I do want to FI/RE.

---

These are the plan's choices:

T Rowe Price Small-Cap Stock (OTCFX)

Fidelity Blue Chip Growth K6 (FBCGX)

Vanguard International Growth Admiral (VWILX)

JP Morgan Large Cap Growth R4 (JLGQX)

MFS Mid-Cap Growth Fund R6 (OTCKX)

Loomis Sayles Small Cap Growth Instl (LSSIX)

Cohen & Steers Instl Realty Shares (CSRIX)

DFA US Large Cap Value Portfolio Instl (DFLVX)

JP Morgan Mid Cap Value R6 (JMVYX)

MissionSquare PLUS Fund R10

Sterling Capital Total Return Bond (BIBTX)

Vanguard Developed Markets Index Instl (VTMNX)

Vanguard Institutional Index Instl (VINIX) --- is this the winner here?

Vanguard Morningstar Small-Cap Idx ADM (VSMAX)

Vanguard Total Bond Market Index Instl (VBTIX)

Vanguard Treasury Money Market Fund (VUSXX)

American Funds 2010 Trgt Date Ret Inc R6 (RFTTX)

American Funds 2015 Trgt Date Ret Inc R6 (RFJTX)

American Funds 2020 Trgt Date Ret Inc R6 (RRCTX)

*American Funds 2025 Trgt Date Ret Inc R6 (*RFDTX)

American Funds 2030 Target Date Ret R6 (RFETX)

American Funds 2035 Target Date Ret R6 (RFFTX)

American Funds 2040 Target Date Ret R6 (RFGTX)

American Funds 2045 Target Date Ret R6 (RFHTX)

American Funds 2050 Target Date Ret R6 (RFITX)

American Funds 2055 Target Date Ret R6 (RFKTX)

American Funds 2060 Target Date Ret R6 (RFUTX)

reddit.com
u/Marvel5123 — 10 days ago
▲ 1 r/DIY

How to secure something into (hollow) brick veneer?

How do you securely mount something into what is believed to be hollow brick (brick veneer on a building).

A quick search said to consider toggle bolts but I’m afraid there are “baffles“ or what not in the brick itself that would prevent the wings from fully opening and laying flat against the inside.

Mesh anchors with epoxy seem like an option but extremely expensive.

What are other good options?

reddit.com
u/Marvel5123 — 12 days ago

How do you mount into (hollow) brick veneer?

How do you securely mount something into what is believed to be hollow brick (brick veneer on a building).

A quick search said to consider toggle bolts but I’m afraid there are “baffles“ or what not in the brick itself that would prevent the wings from fully opening and laying flat against the inside.

Mesh anchors with epoxy seem like an option but extremely expensive.

What are other good options?

reddit.com
u/Marvel5123 — 13 days ago
▲ 1 r/Makita

How many are running (XGT) string trimmers without the guard? Is overload (flashing green) a common issue?

Made switch from a gas (Shindaiwa) string trimmer. Have been using without guard (wear full face shield) and find it much easier to use and can see why many pros do the same.

Picked up GRU01 40V XGT. Tried with guard and worked with no issues. Took the guard off and admittedly pushed it past the 15" cutting swath it is engineered for. In my mind, with the motor and direct drive (plus 40V XGT system), this wouldn't have been an issue but found that if it even slightly just past the 15" swath it would send a flashing green overload light. This is with 4.0 Ah standard battery.

Is anyone running XGT string trimmers without guards? Are the options to just carefully monitor and make sure it doesn't get too far? I do have a BL4040F but I haven't tried it to see if it would make a difference (presumably not because my understanding is the tool and battery have independent monitoring systems?).

Is this just a limitation of battery OPE that users need to understand? Thank you!

reddit.com
u/Marvel5123 — 15 days ago

Retiring in nine months after 15 years with company. Have historically been underpaid and unrecognized. How to negotiate an exit package?

Worked for non-publicly traded company for 15 years. Have always had exceptional performance, however company management/ownership has never really recognized through promotions/raises.

Planning to retire in 9 months. Will have a handful of years between retirement and Medicare. Job field (which involves artistic ability) is being heavily influenced by AI. Recent notice from company was my section's members are being divided up and sent to other depts.

What is the best approach to negotiate an exit package here? Is it worth asking for some sort of COBRA subsidy? Ask for some sort of severance payment to retire?

Is it a bad approach at this point to be maximally aggressive in asking for a package with the mindset there is nothing to lose? Open to any and all advice. Thank you.

reddit.com
u/Marvel5123 — 26 days ago
▲ 8 r/Dallas

Medical professionals of DFW: Do faculty at UTSW practice at both PMH and UTSW?

Question for Southwestern medical professionals.

Do faculty physicians at UTSW spend time practicing at both UTSW and PMH? Does this depend on specialty?

Curious what the relationship between the two are. Is UTSW the academic/teaching hospital and physicians rotate through PMH for county hospital exposure?

Thank you!

reddit.com
u/Marvel5123 — 27 days ago
▲ 0 r/Pomade

How is this oil-based pomade...and how exactly are you suppose to use it?

How is this Japanese pomade?

Have used Suavecito for a while but never used oil-based.

How is this type of pomade intended to be used since it is so hard to wash out? Do people literally leave it in for a couple of days?

Would this be a bad choice for somebody who intends to always wash/shampoo their hair before going to sleep? I keep reading Aussie three minute miracle, but would any conditioner work? Is just a few min of contact, say while brushing, enough to dissolve and allow it be shampooed out? Would dish soap work?

u/Marvel5123 — 1 month ago

I want to make the switch to electric. Is the F-150 Lightning a strong choice?

Currently have a gas F-150 that has 200k+ miles and planning on eventually replacing it.

I am set on replacing with electric but not decided on what vehicle. I especially like the interior size/room of my super crew F-150 and we do occasionally use the bed for carrying things, but it’s not used daily and we do not tow anything.

When I researched EV trucks, it seemed like the options were fairly limited and some of them (Silverado EV, Sierra EV, Rivian) are quite expensive relative to say, a F-150 lightning.

My main question is, how concerning is the fact that Ford discontinued the lightning? I particularly value reliability and worry about finding parts or technicians who can work on it, if and when service is needed.

reddit.com
u/Marvel5123 — 1 month ago

What are the time proven flat roof options? EPDM vs TPO vs MODBIT vs hot mop?

I know nothing about flat roofs but wanted to learn some real-world experiences and opinions from pros.

Is there a system that is objectively the “best” in all instances but perhaps just not used due to cost or is it truly application specific?

I am still a bit confused on MODBIT. Is this the same thing as torch down?

What system is most preferable if you worry about penetrations from trade on the roof?

EPDM on the surface seems like the joints (even primed and glued) would be weak.

I am in an are where runs of 100F plus days is not uncommon. We do not get freeze thaw cycles except for the occasionally snow/ice storm every couple years.

Curious to hear what the engineering pros think and spec.

reddit.com
u/Marvel5123 — 1 month ago

Basic crash course on flat roofs: EPDM vs TPO vs MODBIT vs hot mop?

I know nothing about flat roofs but wanted to learn some real-world experiences and opinions from pros.

Is there a system that is objectively the “best” in all instances but perhaps just not used due to cost or is it truly application specific?

I am still a bit confused on MODBIT. Is this the same thing as torch down?

What system is most preferable if you worry about penetrations from trade on the roof?

EPDM on the surface seems like the joints (even primed and glued) would be weak.

I am in an are where runs of 100F plus days is not uncommon. We do not get freeze thaw cycles except for the occasionally snow/ice storm every couple years.

reddit.com
u/Marvel5123 — 1 month ago

Do health insurances company actually record calls? If so, is agent provided information enforceable?

when we call insurers, we always get a reference number for the call. we have heard they record calls but at the same time, there is an automated disclaimer typically that “benefits are subject to the terms in the policy etc”

my question is, if a representative gives information (ex: X is covered, or X doesn’t require PA) and it turns out to be incorrect, would they review (if an appeal is filed) the call?

are all calls recorded and stored for this purpose? or would they say agents occasionally provide incorrect information, refer to plan document?

reddit.com
u/Marvel5123 — 1 month ago