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c/insurancefights·submitted 2 years ago by u/janoshik_junkie

small win: step therapy stopped being a problem at week 35

Discussionbranch of 6 comments

Posting this because I searched for it and got nothing useful. Setup: 15mg, week 75, injection-site soreness present but not ruining anything. I changed exactly one variable — copay — and tracked it for 17 weeks. Result: a difference, but a small one, and well inside what I would call noise if someone else posted it.…

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6 comments, started 2 years ago
u/maren_ibarra159 points·2 years ago

Inter-lab variance on this kind of assay is routinely 1–2 points. Different column, different gradient, different integration.

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u/tomas_lehtinen133 points·2 years ago

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

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u/formulary_fighterMOD84 points·2 years ago·edited

Flair changed to match the content. Read the sidebar before posting next time and we are square.

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u/tuva_aalto19 points·2 years ago

Flair changed to match the content.

Yes, exactly this, and it is the bit that took me 5 weeks to accept.

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[deleted]8 points·2 years ago

[deleted]

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u/neha_erdogan3 points·2 years ago

copay is separate from coverage

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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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