does step therapy actually matter or is it forum lore at this point
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 2 weeks and cost roughly what I expected. The admin was worse than the cost. The thing that would have saved me the most time was knowing which document to ask for at the start.
Happy to answer questions from anyone in the same jurisdiction.
best — the order this archive was captured in
prior auth criteria are state-specific, prior authorization differs
the carve-out clause varies by employer
This is correct. Appeal letters work.
Did you get step therapy or outright denial?
say which country and which plan type
copay is separate from coverage
This is correct. Appeal letters work.
prior auth criteria are state-specific, external review differs
This is correct. Appeal letters work.
External review overturned the denial. Took 24 weeks but the process exists.
- 1This is correct. Appeal letters work.7 comments in this branch · started by u/elin_lindqvist