the step therapy thing finally clicked for me and I want to write it down
The title is the argument: the step therapy thing finally clicked for me and I want to write it down. Here is the rest of it. New plan year, entirely new criteria, and the denial that had been immovable in the autumn simply did not apply in January. Peer-to-peer took fifteen minutes and resolved something a written…
This. Step therapy is a paperwork requirement and it is beaten with documentation, not persuasion.
Documented eighteen months of what had been tried in a one-page table. That table was the appeal.
Not convinced. That is a formulary exclusion rather than a prior authorisation denial, and the route to challenge it is different.
ask for the clinical policy bulletin by number
Same view. The second-level appeal is where mine turned, after a first-level denial that looked final.
Right, and keeping every date and reference number turns a frustrating process into an auditable one.