[Discussion] the appeal advice in here is 3 years out of date
formulary. That is the whole post, but I will justify it.
Everything else people worry about in c/meta is downstream of it. Titration speed, muscle cramps, the endless dose arguments — most of it resolves if you sort formulary out first, and almost nobody does.
I say this having got it wrong for 3 months. My hs-CRP was the thing that eventually made me pay attention, which is a stupid way to learn a lesson that was in the sidebar the whole time.
best — the order this archive was captured in
Disagree but this is the good kind of wrong — it is specific enough to be checked.
resubmission after denial requires new documentation
Retitled to remove editorialising. Put the evidence in the body.
Not to be pedantic but copay and step therapy are being used interchangeably and they are not interchangeable in real life.
do not suggest misrepresenting a diagnosis, that is fraud
Yeah, the denial code matters, it tells you what to fight.
Disagree but this is the good kind of wrong — it is specific enough to be checked.
prior auth criteria are state-specific, formulary differs
Strongly agree. Step therapy is predictable if you have the criteria.
External review overturned the denial. Took 4 weeks but the process exists.
This is correct. Appeal letters work.
Which plan type? external review is different.
Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.
resubmission after denial requires new documentation
resubmission after denial requires new documentation
Disagree on that part. 98.7% and 98.9% on the same vial is normal.
This is correct. Appeal letters work.
step therapy documentation is the weapon, use it
Strongly agree. Step therapy is predictable if you have the criteria.
- 1This is correct. Appeal letters work.8 comments in this branch · started by u/hplc_hobbyist
- 2Retitled to remove editorialising. Put the evidence in the body.4 comments in this branch · started by u/step_therapy_s