Insurance company refusing meds?

Kristri07

So the doctor prescribed me Zofran for my INSANE morning sickness since I was unable to move at all without getting sick throughout the day.  When I went to pick up the medication my insurance actually denied the pills and said that I should make more of an effort to eat smaller meals?  Has this happened to anyone?  Any ideas how to remedy the situation?  I have about one day left of the Zofran and I am finally starting to feel like myself.  I'm nervous that as soon as I run out, I'll go back to not being able to function.

windycitygigi

Call your doctor and have him/her call the insurance company. ?Doctors do this all the time.

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Kristri07

windycitygigi:

Call your doctor and have him/her call the insurance company.  Doctors do this all the time.

 

 

Actually the doctor called and let them know that I was at risk of going to the ER because of the dehydration and the insurance company says that they need documentation that I tried to remedy the situation without the pill because the pill is so expensive.  This is making me nuts.   I love that I pay for health insurance, and when I actually NEED it, they decide to hold out.

I LUBBINS YOU!

Health insurance companies are horrible.  They look at the cost, vs the patient and situation.  They would rather you take a chance and go to the ER than pay out for medicine that is necessary....which will probably cost way more.

windycitygigi

If it's something you really need, and the doctor can't convince the insurance company, then you may just have to pay for it out of pocket and continue to fight witht he insurance company for repayment.

Have you tried contacting the manufacturer? ?Does the drug rep have samples? ?Is there a generic available??

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Samantha82

This hasn't happened to me, but I read someone elses story either on another board or their blog.  The insurance also denied the drug.  She had to wait another week or so and then the doctor wrote a note to the insurance company and faxed it.  Then they approved it.  I think basically you have to have your doctor request it several times because it's so expensive.  You should call them and ask what proof they need.  When an insurance company denies a claim you have the right to know exactly why but also what you need to do to get them to approve it.

You think they would just approve the drug, since you would think they would not want to pay for the ER visit if you end up there because of dehydration.

Good luck!

Kristri07

The worst part is, I changed insurance plans about 6 months ago so I could plan on having the "best" possible insurance for maternity and newborn care.  ::sigh::

 Thanks for the advice though.  I talked to the doctor and the insurance company today but I think I might try contacting the insurance company tonight (when my coworkers cant hear me yelling) and ask them what needs to be done.  It's amazing that there are things out there to help girls with severe morning sickness and then some idiot in an office can just say no without ever meeting me.  Grrr.   I think I've gone from defeated to furious.

sandollar

It seems to me that doctors have started prescribing that drug to anyone and everyone who has a little nausea. I guess the insurance companies noticed and are trying weed out the people who may not really need it since is so expensive.

Temp23782687501318

If you would have to pay out of pocket, and you have AAA, they have a discount presciption drug program that is free to members.  That might help you save some money on it.

I hope you get resolution soon!

jonsdeedee

Call your HR department.  Medco did this whole clusterfuck thing with a med of DH's because it was a controlled substance that none of their stellar pharmacists wanted to fill.  I spent hours on the phone with them and it was only filled after the head of DH's HR department called them and read them the riot act.

peppermintgirl

Zofran is expensive, so a lot of insurance companies will either flat out deny it, or they won't give the full prescription. Both happened to me. I got the prescription after spending a couple hours in an emergency clinic getting IV fluids. At first, our insurance completely refused to cover it. My OB had to call the company and explain to them that if I did not get the medication, they'd probably be paying for several hospital stays because I couldn't hold anything down. They tried suggesting eating smaller meals more frequently and drinking Pedialyte, but after a couple more calls, they agreed to cover the medication. I was supposed to get enough, with a refill, so that I could take two per day until my next appointment with the OB. Instead of getting the prescribed thirty, they would only give me twenty, and with no refill. So I can't even take one per day until my next appointment. I'm still getting sick and losing weight, and I'm dreading trying to fight with them to get another prescription approved.

Kristri07

sandollar:

It seems to me that doctors have started prescribing that drug to anyone and everyone who has a little nausea. I guess the insurance companies noticed and are trying weed out the people who may not really need it since is so expensive.

 I actually read about that too.  I originally thought that it was geared towards only pregnant women and cancer patients but when I researched a little more I noticed alot of ERs are prescribing to children with nausea and vomiting.

deb2126

I'm on Zofran as well, it does help a lot. My insurance company will only pay for 24 pills a month, I didn't know about that last month so I took them every twelve hours as directed. This month I am hoarding them like nobody's business. When I called my insurance company they told me the Dr. would have to call in an approval for the medicine, my doctor wouldn't but they did write me a prescription for something else until the month was up. I'm back on Zofran today and I'm actually about to keep food down. good luck!

Kristri07

peppermintgirl:

I was supposed to get enough, with a refill, so that I could take two per day until my next appointment with the OB. Instead of getting the prescribed thirty, they would only give me twenty, and with no refill. So I can't even take one per day until my next appointment. I'm still getting sick and losing weight, and I'm dreading trying to fight with them to get another prescription approved.

 

This is EXACTLY where my problem started.  The doctor keeps prescribing me 30 pills to get me to my next appointment and Aetna will only give me 12 at a time without any refills until at least 30 days. The doctor wanted me to take 2-3 pills a day but now I am hiding them away and trying to take as little as possible.  Which I am sure you know, leads to more vomiting.

I hope you feel better and get the prescription you need.