[Question] copay — what am I missing here
Quick one. Canada here. step therapy works very differently where I live than in the threads that dominate the front page, and I keep seeing people confidently given advice that simply does not apply outside the US. Specifics: the route I used took 3 weeks and cost roughly what I expected. The admin was worse than…
Sweden plan: step therapy required 15 medications first. Did them all, got approval. The order matters.
say which country and which plan type
That is net peptide content, not purity. Different number, different meaning.
prior auth criteria are state-specific, denial differs
appeal letter templates are in the wiki
Yeah, the denial code matters, it tells you what to fight.
redact member ids and group numbers from every screenshot
redact member ids and group numbers from every screenshot
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
External review overturned the denial. Took 3 weeks but the process exists.
This is correct. Appeal letters work.