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c/insurancefights·submitted 7 months ago by u/valeria_grimaldi

the denial question that gets asked weekly, answered properly

Discussionbranch of 4 comments

Genuinely asking, not being difficult. Everyone in c/labresults repeats that prior authorization is important. I believe it, but I have never seen anyone show why, and when I search I get 17 threads of people agreeing with each other. Is there a paper? Is there a measurement? Or is this one of those things that is…

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4 comments, started 7 months ago
u/step_therapy_sMOD207 points·7 months ago

Removed a chain here. The rule is one line long and it is not negotiable.

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u/valeria_grimaldiOP113 points·7 months ago

Denied for prior auth, resubmitted with step therapy documentation, approved on appeal. The criteria exist, you just have to meet them.

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u/step_therapy_s95 points·7 months ago

Yeah, the denial code matters, it tells you what to fight.

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u/valeria_grimaldiOP52 points·7 months ago

Poland plan: step therapy required 6 medications first. Did them all, got approval. The order matters.

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About c/insurancefights

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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