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 written appeal had been sitting on for a month.
Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle.
Would rather be corrected in public than confident in private.
best — the order this archive was captured in
Appeal deadlines run from the date on the determination letter. They are strict, they are short, and a missed deadline usually forfeits that level entirely.
the second-level appeal is where things actually turn
deadlines run from the letter date, not from when you opened it
deadlines run from the letter date, not from when you opened it
Adding the underused one — external review. Independent, binding where it applies, and hardly anybody gets that far.
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.
- 1Same view. The second-level appeal is where mine turned, after a first-level…6 comments in this branch · started by u/ferritin_low