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c/insurancefights·submitted 5 months ago by u/vito_beaulieu

three years of step therapy threads, summarised so you do not have to read them

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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…

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6 comments, started 5 months ago
u/saskia_rahimi15 points·5 months ago

Disagree with the tone strategy. Anger has never moved a determination; matching the criterion has.

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u/sofia_ferreira4 points·5 months ago

ask for the clinical policy bulletin by number

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u/kasper_cabrera1 point·5 months ago

Same view. The second-level appeal is where mine turned, after a first-level denial that looked final.

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u/vito_beaulieuOP1 point·5 months ago

Correcting myself upthread: the deadline was 6 days, not the figure I gave.

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u/dose_diary_danalog keeper1 point·4 months ago

Cosigning on external review. It is a real mechanism, it is underused, and the deadlines are strict.

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u/blunt_coldbox_notes1 point·4 months ago

ask for the denial reason in writing, always

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About c/insurancefights

The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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