About to pull out my hair!

MallardDucky

I have been fighting for a month about ds1's meds. His insurance for some reason stopped covering them. We fought like hell and even his doctor was like he has been on these for almost 3 years. Well we found out last week they denied it.

So his doctor prescribed something else tada denied for that med too. My child has been without ADHD meds for a month, A MONTH!

His grades are being effective and the insurance is just pulling us around. I called today and I wasn't very nice and asked what med they will cover. It's a med that does not work at all for him. (It's what we originally started with back when he was 4).

Any other thoughts or advice that I can try with the insurance?

NoSoup4You

I would try your insurance's appeal process. You'll need to call and get the details from them about where to send it to. You'll also need a letter from your son's physician indicating the need and that you've already tried the other meds. A lot of companies are doing a step process for prescriptions these days, so you basically have to prove that everything under the sun doesn't work until they'll pay. The appeal may not work, but it's worth a try. Good luck!

MallardDucky

NoSoup4You said:

I would try your insurance's appeal process. You'll need to call and get the details from them about where to send it to. You'll also need a letter from your son's physician indicating the need and that you've already tried the other meds. A lot of companies are doing a step process for prescriptions these days, so you basically have to prove that everything under the sun doesn't work until they'll pay. The appeal may not work, but it's worth a try. Good luck!

This was the first thing we started and got the word today that it was denied. And that's why we tried the new med. It is getting a little overwhelming

ppants

Does insurance provide a reason for the denial?  I'm sorry both of you are having to deal with this.  My kids are both on daily asthma meds which they need so I can only imagine how you feel.  ((hugs))

MallardDucky

ppants said:

Does insurance provide a reason for the denial?  I'm sorry both of you are having to deal with this.  My kids are both on daily asthma meds which they need so I can only imagine how you feel.  ((hugs))

The only thing we are getting from them is that they restructured and want him to start over on meds. Like what we did when he was 4 and went through meds to see which worked for him (going through the tiers again).

Pearls+Oysters

Seriously, they want to treat a 7yo like a guinea pig all over again when he already has one medication that works? Poor kid... This isn't only unfair to your family, it might actually jeopardize his health and grades, his self-esteem might suffer, etc. 

I'm sorry you're going through this. What does his doctor think?

ppants

That's ridiculous and an awful to subject your son to.  Can his previous records be sent over and reviewed by insurance when he was trying the tiers of meds?  What about also including any student records during the time when he was trying meds?  If there's no such record, maybe previous teachers would be willing to write a letter about their experience with your son during that time.  I would submit letters from current teacher(s) and any other professionals he sees to try to support your claim.  I would also want to speak directly with a supervisor or someone making this decision about the claim.

MallardDucky

His doctor is sending up appeals after the denials. She thinks it's stupid.

His grades are already affected, he went from passing in reading to failing (it's a pass or fail grade for the math).

It's been brought to the schools attention and they are now getting involved.

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MallardDucky

I called today to get a price and about fell out my chair. Apperantly there is a shortage so cost is way expensive. $600 for a 30 day supply. If it was around $100 we could do that but $600 is more then our rent.

ppants

Sounds like you found the real reason why.  We often run across drug shortages at my job also.  When will production ramp up again?  You are doing all you can it seems.  Hang in there!