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c/insurancefights·submitted 1 months ago by u/sock_puppet_spotter

does step therapy actually matter or is it forum lore at this point

Winbranch of 7 comments

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…

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7 comments, started 1 months ago
u/elin_lindqvist80 points·1 months ago

This is correct. Appeal letters work.

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u/dose_diary_danalog keeper22 points·1 months ago

Did you get step therapy or outright denial?

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u/honest_syringe1918 points·1 months ago

say which country and which plan type

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u/dose_diary_danalog keeper9 points·1 months ago

copay is separate from coverage

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u/blunt_coldbox_notes5 points·1 months ago

This is correct. Appeal letters work.

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u/sofia_ferreira6 points·1 months ago

prior auth criteria are state-specific, external review differs

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u/sock_puppet_spotterOP4 points·1 months ago

This is correct. Appeal letters work.

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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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