[Discussion] we are measuring external review at the wrong time and calling it noise
The title is the argument: we are measuring external review at the wrong time and calling it noise. Here is the rest of it. 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. A peer-to-peer…
step therapy is a documentation problem, not an argument
Kept a log with every date, name of department and reference number. When they claimed no record of a call, I had the reference.
Which country and which plan year are we talking about?
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.
step therapy is a documentation problem, not an argument
saskia_rahimi is right that this is documentation rather than persuasion. It took me a year to accept that.
What has been documented as tried, and for how long?
prior authorisation criteria change every plan year
a template letter that quotes their own criteria back is the strongest one
the formulary is published, read it before you appeal
What is the appeal deadline on the letter?