Why does everything have to be a fight with them?!?!
I went to the pharmacy today to pick up Madison's prescription for Prevacid for her reflux. I am told that the generic brand is on backorder from the manufacturer. No one can get it. So, I ask them for the name brand kind. I am then told that the insurance co. won't pay for the name brand, only generic.
The pharmacist, who bless her heart was extremely nice and helpful, called a supervisor from the ins. co. and explained the situation. I have a 9 month old baby that has moderate reflux. Again, she is a BABY! She's not an adult that has the option of taking a different form of the pills nor she doesn't have the option of taking an over -the-counter medicine in the meantime. She needs her Prevacid!
The supervisor explains to the pharmacist that my only option is to have Madi's pediatrician write a letter to the ins. co. explaining to them that having a name brand medication is a "Medical Necessity". Okay, what?!?! I thought the doctor writing out a prescription states a medical necessity for the drug.
Once the doctor writes this letter to them, they will have underwriting evaluate it and either approve or disapprove the name brand version vs. the generic brand. Oh......and this can take several weeks to get approved.
Sooooooo..........can you tell me Ins. Co. what I am supposed to do with my 9 month old baby in the meantime? Do I not give her the medication and let her wretch her body around in pain and vomit after every meal? Do I try a different medication, in the "hopes" that it might work? Really?!?! We have struggled to finally get her reflux under control and now I am just supposed to switch things up because they don't want to approve a name brand drug vs. generic.
Basically, my only option right now is to pay for the drug myself out of pocket. Well, I just bought 4 pills for $30. And that was with the pharmacist putting it down that I have a discount program, which I don't. So, I don't even know what the pills would really cost.
What are we paying our health insurance premiums for, anyways? They just fight everything anyways.
I have done nothing but fight with ins. co. since I was diagnosed with breast cancer and now I fight for them to cover Madi's appts.
I apologize for my rant.......but I am just fed up!!!
This is what Madi thinks of this too.......
3 comments:
OH Karrie, that is horrible! I have had it with ins companies too. I'm still not done with a claim from 2008 when I had my daughter. They submitted it as a NICU baby which she wasnt, and charges were ridiculous. So my ins company was trying to make me pay for the excess and I had to write and appeal and it was a big mess. feel for you, Maddy has no choice in this and she needs her medicine. How frustrating! i'm so sorry :(
Claire is on Prevacid too and we've had her on the OTC forever (since she's been 10ish months old). We break the pills open, split the dots in half and add them to a bite of applesauce or yogurt. At first, when her reflux was worse we would do this about 20 minutes before her meal. Now we just get it down with dinner and she's fine. Claire HATED the dissolving tablets and this was the only way we could get the meds in her (she quit eating solids all together after we introduced the dissolving tablets). I don't know what dose she's on, but wanted to throw that out there for you. :)
I'm so sorry you are dealing with this...I hate arguing with them too. I feel like we never win the battles! You can rant anytime!
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