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c/insurancefights·posted 2 years ago by u/canada_coverage

step therapy — 16 things I got wrong before I got it right

Template Cold Box ×8

Right, the external review question again, but with numbers this time.

I have 20 data points over 32 weeks. The pattern is consistent enough that I do not think it is chance, and boring enough that nobody is going to screenshot it, which is usually a good sign.

The thing I would flag for anyone new: the effect I am describing showed up at week 55, not week 9. People give up long before the interesting part.

Interested in whether this matches other people's logs or whether I am an outlier.

338 up / 12 down97% upvoted7 commentsid gz2fnx8 Jan 2024

7 comments

6 in this archive, depth 3

best — the order this archive was captured in

u/neha_erdogan22 points·2 years ago

Yeah, the denial code matters, it tells you what to fight.

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u/pavel_nkemelu-18 points·2 years ago

This is correct. Appeal letters work.

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u/ismael_nwosu1 point·2 years ago

Did you get step therapy or outright denial?

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u/emeka_delgado1 point·2 years ago

say which country and which plan type

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u/appeal_letter_alMOD1 point·2 years ago

Flair changed to match the content. Read the sidebar before posting next time and we are square.

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u/greta_chukwu1 point·2 years ago

denial reason codes matter, ask for the actual code

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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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