three years of step therapy threads, summarised so you do not have to read them
three years of step therapy threads, summarised so you do not have to read them. It is the sort of thing everyone half-believes and nobody writes down. External review was the thing that finally worked. I did not know it existed until a thread on this board. Documented eighteen months of what had been tried in a…
Employer-sponsored plans may be regulated differently from individually purchased ones, which changes both the appeal route and which regulator hears a complaint.
Prior authorisation criteria are republished each plan year. A criterion that blocked you in one year may not exist in the next, so a denial is worth retesting after the turnover.
Asked for the policy bulletin by number and wrote the appeal against its criteria line by line. Approved on the second level after a flat first-level denial.
That criterion is from the previous plan year. The current bulletin has different wording.
the second-level appeal is where things actually turn
the second-level appeal is where things actually turn
Agreed — and request the bulletin by number. They have to give it to you.
a peer-to-peer call is often faster than a written appeal
step therapy is a documentation problem, not an argument