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c/insurancefights·submitted 6 days ago by u/emeka_delgado

[Question] step therapy — how do i document failing something cheaper

Questionbranch of 6 comments

Genuinely asking, not being difficult. Everyone in c/labresults repeats that formulary is important. I believe it, but I have never seen anyone show why, and when I search I get 14 threads of people agreeing with each other. Is there a paper? Is there a measurement? Or is this one of those things that is true because…

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6 comments, started 5 days ago
u/ferritin_low24 points·5 days ago

Rodent data is rodent data. Dose scaling is not linear and the models tell you what to investigate, not what to expect.

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u/rekha_vestergaard15 points·5 days ago

redact member ids and group numbers from every screenshot

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u/ferritin_low20 points·5 days ago

denial reason codes matter, ask for the actual code

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[deleted]6 points·4 days ago

[deleted]

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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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