step therapy is the most under-discussed thing on this board
step therapy is the most under-discussed thing on this board. 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 one-page table. That…
document what has been tried and for how long, that is the whole case
document what has been tried and for how long, that is the whole case
Adding the underused one — external review. Independent, binding where it applies, and hardly anybody gets that far.
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.
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.
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.
Disagree with the tone strategy. Anger has never moved a determination; matching the criterion has.