unpopular opinion: most of what gets said here about step therapy is guesswork
The title is the argument: unpopular opinion: most of what gets said here about step therapy is guesswork. Here is the rest of it. New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January. Peer-to-peer took fifteen minutes and resolved something a…
Same view. The second-level appeal is where mine turned, after a first-level denial that looked final.
the denial letter names the criterion, start there
a peer-to-peer call is often faster than a written appeal
keep every date, every reference number, every name of a department
Not convinced. That is a formulary exclusion rather than a prior authorisation denial, and the route to challenge it is different.
Agreed on the plan-year point. Criteria that applied last year may simply not apply now.