[Question] step therapy — how do i document failing something cheaper
step therapy — how do i document failing something cheaper. I would rather ask a basic question now than get this wrong quietly for two months. 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. Spent six weeks…
employer plans and individual plans are different fights
the formulary is published, read it before you appeal
Employer plan or individual plan?
Have you asked for the clinical policy bulletin by number?
Is this a prior authorisation denial or a formulary exclusion?
appeal in writing even when they say a call is enough
external review exists and almost nobody uses it
document what has been tried and for how long, that is the whole case