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Discussion Starter #1
I have been taking a drug ( tried other homeopathy first and still mix this chemical with Magnesium Maleate for maximum benefit) before we had to switch<br>
Before the switch I checked their formulary and it was on there. hooray no<br>
'prior authorization' like the previous ins. Hahahaha. At least the previous did it quick no fuss no mess as I am allergic to sulfa drugs.<br>
I had enough to carry me through April and tried to fill it the first time in April with this company.<br>
They denied it saying I had no form of arthropathy -umm guys osteoarthritis and Fibro fall under Websters Definition of Arthropathy not to mention the RA markers in the last bloodwork. THeir pharmacist said she had never heard of fibro and what was it exactly <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/rolleyes.gif" style="border:0px solid;" title="rolleyes"><br>
SO she proceeds to tell me to have my pcp send : the original arthritis diagnosis from when I was 16 -my oldest son is 17 now so they had to go back that far??? the rediag. from my twenties, the date of the fibro diag, the diag from the ortho on degenerative disease, the documented fact of sulfa allergy ( she asked i really was and was it just a rash i explained no they could pay the er or funeral expenses ) and the paperwork from the prior company where they authorized the meds use.<br><br>
So my drs kickass nurse sent all of this. I can't imagine the time it had to take her to sift through that file....<br>
I called pharmacy line at the ins company today and he said 'oh we got all that but we are now denying it because even though the other criteria is met you don't have peptic ulcer or gastrointestinal hemorrage. " WTH? The latter happens in people who DON"T tolerate vioxx well!!! So we meet their reqs and are still told no!<br>
ANd in the appeals it says if it will jeopardize your maximum mobility umm yeah duh without it I would be in full flare all the time instead of some of the time<br>
and it has helped some IC symptoms unexpectedly. I hate this. This is the first problem with this HMO and its a doozy. With the other one I knew the game and the moves GRR and this one is three times as much as the other one and the only reason we can get is he got a 1.5% raise which we never see since it pays for this.<br>
But I am thinking super shady characters you give them what they ask for and they try something else?<br>
AND this drug IS on their third tier now meaning you pay a high copay for a non formulary . And the site has changed to say it now requires an authorization where it didn't before.<br>
Losers.<br>
Anyway the pharm guy this morning after I said "thank you that is what I need to file my complaint with the state ins board " said 'if you think you must":<br>
Umm yeah duh!<br>
And the old co. I took to the ins board 3 times 3 wins so these people won't know what hit em/<br>
The nurse said he figures I won't follow through because patients get fed up with red tape and paperwork.
 

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Insurance compaines are a pain. I have no idea why they do the things they do. Luckily you have a dr..or his staff rather...that understands how stupid some companies could be. I used to bill ins cos and you wouldn't believe the crap they require.<br><br>
I hope you get this all worked out...it really sucks <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">
 

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Discussion Starter #3
My pcp is a female ( and she takes no guff from the ins and paper pushers making med decisions that know nothing about it -and I mean the accts and such that have no med knowledge just bottom line cost stuff)<br>
I have had to sleep with the devil on this one-meaning I sent copies of the complaint to the pharma company that makes it even though I have written, emailed and called them with many protest over vaxes....*sigh*
 
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