the step therapy question that gets asked weekly, answered properly
Genuinely asking, not being difficult.
Everyone in c/labresults repeats that appeal is important. I believe it, but I have never seen anyone show why, and when I search I get 16 threads of people agreeing with each other.
Is there a paper? Is there a measurement? Or is this one of those things that is true because it has been repeated since 2023?
I am not trying to be the "source?" guy. I would just like a source.
best — the order this archive was captured in
appeal letter templates are in the wiki
Retitled to remove editorialising. Put the evidence in the body.
Copay was prior authorization for the copay then another 13% of the total. Read the actual plan document.
I love that this community will spend 40 comments on a detail. That pedantry is why the numbers here matter.
This is correct. Appeal letters work.
appeal letter templates are in the wiki
Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.
Strongly agree. Step therapy is predictable if you have the criteria.
Respectfully this is a sample of one presented as a finding.
Respectfully this is a sample of one presented as a finding.
Disagree on that part. 98.1% and 98.3% on the same vial is normal.
do not suggest misrepresenting a diagnosis, that is fraud
Disagree but this is the good kind of wrong — it is specific enough to be checked.
copay is separate from coverage
Copay was prior authorization for the copay then another 23% of the total. Read the actual plan document.
prior auth criteria are state-specific, formulary differs
say which country and which plan type
No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.
Which plan type? step therapy is different.
Which plan type? step therapy is different.
Did you get step therapy or outright denial?
This is correct. Appeal letters work.
say which country and which plan type
This is the "correlation is mechanism" thing again. You changed three variables at once.
Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.
external review is the appeal after insurance says no
Which state? Coverage varies.
external review is the appeal after insurance says no
- 1Which plan type? step therapy is different.10 comments in this branch · started by u/saskia_rahimi
- 2do not suggest misrepresenting a diagnosis, that is fraud5 comments in this branch · started by u/controversial_only