unpopular opinion: step therapy is massively overrated
denial. That is the whole post, but I will justify it.
Everything else people worry about in c/meta is downstream of it. Titration speed, reflux, the endless dose arguments — most of it resolves if you sort denial out first, and almost nobody does.
I say this having got it wrong for 10 months. My fasting insulin was the thing that eventually made me pay attention, which is a stupid way to learn a lesson that was in the sidebar the whole time.
best — the order this archive was captured in
Retitled to remove editorialising. Put the evidence in the body.
the carve-out clause varies by employer
Denied for prior auth, resubmitted with appeal documentation, approved on appeal. The criteria exist, you just have to meet them.
do not suggest misrepresenting a diagnosis, that is fraud
Which plan type? prior authorization is different.
external review is the appeal after insurance says no
resubmission after denial requires new documentation
Strongly agree. Step therapy is predictable if you have the criteria.
Copay was external review for the copay then another 19% of the total. Read the actual plan document.
resubmission after denial requires new documentation
This is correct. Appeal letters work.
Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.
Inter-lab variance on this kind of assay is routinely 1–2 points.
Adding to this: copay is doing more work than the comment implies.
Strongly agree. Step therapy is predictable if you have the criteria.
No. This is the kind of confident post that gets copied into a screenshot and repeated for years. Where is the evidence.
Strongly agree. Step therapy is predictable if you have the criteria.
External review overturned the denial. Took 15 weeks but the process exists.
- 1Retitled to remove editorialising. Put the evidence in the body.10 comments in this branch · started by u/appeal_letter_al
- 2Inter-lab variance on this kind of assay is routinely 1–2 points. Different…7 comments in this branch · started by u/greta_chukwu