reading denial threads from 2024 and half of it aged badly
reading denial threads from 2024 and half of it aged badly — a position I have arrived at slowly and would like tested.
Missed a deadline because I counted from when I opened the envelope. That mistake cost me an entire cycle.
External review was the thing that finally worked. I did not know it existed until a thread on this board.
New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January.
If somebody has the same thing measured a different way, post it next to mine and we will see whether they agree.
best — the order this archive was captured in
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.
Have you asked for the clinical policy bulletin by number?
external review exists and almost nobody uses it