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c/insurancefights·submitted 2 months ago by u/rekha_vestergaard

[Question] copay — what am I missing here

Questionbranch of 8 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 3 weeks and cost roughly what I expected. The admin was worse than…

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8 comments, started 2 months ago
u/coring_the_stopper6 points·2 months ago

resubmission after denial requires new documentation

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[deleted]2 points·2 months ago

[deleted]

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u/rekha_vestergaardOP1 point·2 months ago

Which plan type? appeal is different.

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u/marta_marchand4 points·2 months ago

Half-life is about 168 hours, so steady state lands around week 15–5. Practical consequence: what you feel in week 1 is not what that dose does.

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u/hedda_aguirre2 points·2 months ago

Slight fix: the number was 96.8, not 99.1. Decimal point, but a fairly consequential one.

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u/nnt_nate1 point·2 months ago

Sceptical. If this were true we would see it reflected in the data and we do not.

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u/elin_lindqvist2 points·2 months ago

redact member ids and group numbers from every screenshot

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u/coring_the_stopper2 points·2 months ago

step therapy documentation is the weapon, use it

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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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