how much of what we believe about appeal actually comes from step therapy threads
how much of what we believe about appeal actually comes from step therapy threads. Searched first, found three threads that contradict each other, hence the post. 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…
Step therapy requires documented trial of preferred alternatives. It is not an argument to be won on merits; it is a record to be produced, and the record is what the appeal must contain.
New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January.
New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January.
This is the whole method. Answer the criterion they named, not the decision in general.
employer plans and individual plans are different fights
Correction: that is a formulary exclusion, not a prior authorisation denial. Different form, different route, different deadline.
Kept a log with every date, name of department and reference number. When they claimed no record of a call, I had the reference.