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c/insurancefights·submitted 29 days ago by u/amira_dumitru

step therapy: the version I wish someone had shown me in week 1

Appealbranch of 5 comments

Quick one. Canada here. external review 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 24 weeks and cost roughly what I expected. The admin was worse…

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5 comments, started 28 days ago
u/kian_ferreira13 points·28 days ago

Strongly agree. Step therapy is predictable if you have the criteria.

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u/amira_dumitruOP10 points·28 days ago

Strongly agree.

Counter-anecdote: opposite result, same dose. Which mostly tells us the variance is huge.

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u/emeka_delgado8 points·28 days ago·edited

redact member ids and group numbers from every screenshot

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u/ahmed_abubakar9 points·28 days ago

prior auth criteria are state-specific, denial differs

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u/kian_balogun11 points·27 days ago

Did you get step therapy or outright denial?

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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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