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c/insurancefights·posted 7 months ago by u/elin_varga

[Results] 56 weeks on 0.25mg, full numbers, ask me anything boring

Appeal Clean Column ×1 Cold Box ×3

Quick one. Canada here.

denial 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 than the cost. The thing that would have saved me the most time was knowing which document to ask for at the start.

Happy to answer questions from anyone in the same jurisdiction.

1,234 up / 198 down86% upvoted49 commentsid c7zs6719 Dec 2025

49 comments

13 in this archive, depth 4

best — the order this archive was captured in

u/prior_auth_painMOD253 points·7 months ago

This is an urgent-care question wearing a forum question's clothes. Please contact a clinician rather than waiting for replies.

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[removed]183 points·7 months ago

[removed by moderator]

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u/tomas_lehtinen152 points·7 months ago

say which country and which plan type

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u/emeka_delgado-36 points·7 months ago

the carve-out clause varies by employer

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u/ahmed_abubakar140 points·7 months ago

Not to be pedantic but step therapy and denial are being used interchangeably and they are not interchangeable in real life.

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u/plain_titration_2024172 points·7 months ago

the UK plan: step therapy required 19 medications first. Did them all, got approval. The order matters.

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u/appeal_letter_al84 points·7 months ago

the UK plan: step therapy required 19 medications first.

Disagree on that part. 99.1% and 99.2% on the same vial is normal.

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u/elin_vargaOP59 points·7 months ago

Sweden plan: step therapy required 24 medications first. Did them all, got approval. The order matters.

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u/elin_varga138 points·7 months ago

external review is the appeal after insurance says no

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u/elin_vargaOP51 points·7 months ago

Copay was denial for the copay then another 3% of the total. Read the actual plan document.

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u/elise_grimaldi166 points·7 months ago

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

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u/neha_rahimi0 points·7 months ago

Which plan type? copay is different.

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u/pavel_nkemelu77 points·7 months ago

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

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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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