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Single comment threadYou are looking at one branch of someone explain step therapy to me like I have not read a paper in years — 22 comments in the full submission. View in context.
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c/insurancefights·submitted 2 months ago by u/elin_lindqvist

someone explain step therapy to me like I have not read a paper in years

Templatebranch of 6 comments

Something I noticed reading old threads that I have not seen said out loud. The advice on prior authorization in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory…

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6 comments, started 2 months ago
u/ferritin_low12 points·2 months ago
saved. thank you.
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u/rekha_mbeki10 points·2 months ago·edited

Strongly agree. Step therapy is predictable if you have the criteria.

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u/honest_syringe197 points·2 months ago

copay is separate from coverage

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u/elin_lindqvistOP4 points·2 months ago

This is correct. Appeal letters work.

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u/line_petrov5 points·2 months ago

Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.

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u/ireland_drugs_pay2 points·2 months ago

appeal letter templates are in the wiki

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About c/insurancefights

The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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