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c/insurancefights·submitted 2 years ago by u/step_therapy_s

[Question] step therapy — what am I missing here

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step therapy — what am I missing here. 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 denial. Employer-sponsored plans may be regulated…

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6 comments, started 2 years ago
u/ismael_nwosu417 points·2 years ago

Have you asked for the clinical policy bulletin by number?

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[deleted]301 points·2 years ago

[deleted]

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u/prior_auth_painappeals199 points·2 years ago

ask for the denial reason in writing, always

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u/amira_dumitru246 points·2 years ago

Small fix — external review is independent of the plan. The second-level internal appeal is not.

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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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