insurance woes!

ToastieSimons

We got a letter from our insurance company stating they won't cover our compounded Baclofen (muscle relaxer) without a letter of medical necessity.  The boys have been on it for years now, nothing new.

So I call the insurance company, the guy was super nice and told me what I needed to do, even faxed the forms right to the dr's office for me.

I called the dr's office, the dr filled them right out and was going to fax them back as soon as she got a new copy of our insurance card.

I was on cloud 9 that this was going so well.  Both boys are napping so I printed out the card, faxed it and took a shower.  Meanwhile, our dr's office submits the forms and gets some strange form back.  It says that this necessity is not needed, it's covered.  That Lansoprazole (prevacid) is also covered.  And that we're trying to fill it too quickly, fill prescription as of May 6.  

So I call the insurance company back.  No...the Baclofen is covered.  1 ingredient in the compound isn't covered.  In order for them to cover a compounded medication they have to approve at least 75% of the ingredients.  our Baclofen compound only has 2 ingredients, Baclofen and Ora+Plus.  They don't cover Ora Plus.  Uhm...how am I supposed to know this stuff?  And how is the dr supposed to know this?  She doesn't compound it.  So now I have restart all this on Monday.  

Blech!

joshsmandy

I'm sorry, this is exactly why I think it is stupid for our ins companies to tell us what we can and can't have, we hired (pay) them and our doctors prescribe things for a reason

ToastieSimons

joshsmandy said:

I'm sorry, this is exactly why I think it is stupid for our ins companies to tell us what we can and can't have, we hired (pay) them and our doctors prescribe things for a reason

Right, for the past 3 years we've just been giving it to him for funsies....But now that you're asking if it's medically necessary....

realisticdreams

ughhh sorry I have a list of 5 things to call the insurance for Mon morning!