[Appeal] the external review process nobody tells you exists
Something I noticed reading old threads that I have not seen said out loud. The advice on external review in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers…
Yeah, the denial code matters, it tells you what to fight.
Australia plan: step therapy required 3 medications first. Did them all, got approval. The order matters.
step therapy documentation is the weapon, use it
Yeah, the denial code matters, it tells you what to fight.
Adding to this: copay is doing more work than the comment implies.
Yeah, the denial code matters, it tells you what to fight.
Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.
What was the denial code?
the carve-out clause varies by employer
step therapy documentation is the weapon, use it