Y'all, it's always something

Madelyn0713

I found out Wednesday insurance denied my refill of Lovenox. They said they'd only cover 30 shots every 90 days. This is a shot I need daily to keep this baby alive. The pharmacy got my RE to appeal and insurance denied the appeal. The doctor is appealing again but said it doesn't look good. This shot is $30 a day and I will be on it for the entire pregnancy. Holy $$$! 

Here's to hoping the second appeal works.... 

woody26

Call this company the safety net foundation 18887626436, they help ppl out that can't afford their prescriptions... I'm currently trying to get my grandfather enrolled, he needs shots weekly and the cost is 260 per month... Also you can try epic 18003323742... needymeds.com.. Not sure if it will work for you but worth a shot. The insurance companies should be ashamed of themselves!
Good luck!

orchid8301

Why is insurance denying it if your doctor says it is necessary? I had some issues last time and I called HR. They were able to help as well.

boogerbearoriginal

OMG! I am so sorry. I hope the next appeal comes through, how awful.

Our system is so effed up in this country.

mab18

I'm really sorry you're going through this. I know how difficult dealing with insurance companies can be. If you can't get it resolved through your insurance, maybe you could try applying for a medical grant. My sister did this during one of her pregnancies when the insurance wouldn't cover something.

RondackHiker

CrisM022:

Why is insurance denying it if your doctor says it is necessary? I had some issues last time and I called HR. They were able to help as well.

Because insurance companies suck? When I delivered my first via c-section, my insurance happily paid for the c-section but refused to pay for the anesthesia. They felt my spinal was 'unnecessary' despite what my doctor said (and common sense would dictate) and wouldn't pay.

They also didn't pay DS's NICU bill, but that's another story. 

kvlrn

I've known a couple people who had to take heparin instead. Could you see if your RE can prescribe that instead of lovenox? Heparin should be covered by your insurance and its just as effective.

Madelyn0713

kvlrn:

I've known a couple people who had to take heparin instead. Could you see if your RE can prescribe that instead of lovenox? Heparin should be covered by your insurance and its just as effective.

I asked about this but they said they'd really prefer to not switch me at this point, since I've been on Lovenox for a month now. It would be a last resort but I think I'd be uncomfortable with that and the potential concerns and just suck it up and pay for the Lovenox OOP.  

kvlrn

RondackHiker:

CrisM022:

Why is insurance denying it if your doctor says it is necessary? I had some issues last time and I called HR. They were able to help as well.

Because insurance companies suck? When I delivered my first via c-section, my insurance happily paid for the c-section but refused to pay for the anesthesia. They felt my spinal was 'unnecessary' despite what my doctor said (and common sense would dictate) and wouldn't pay.

They also didn't pay DS's NICU bill, but that's another story. 

That's bull crap. How is a spinal "unnecessary"??? Or do they not know that regional anesthesia is preferred over general for the wellbeing of the baby? We generally like babies to BREATHE when they are born! Or maybe they would pay for you to bite down on a rag instead. That makes me mad for you!

kvlrn

Madelyn0713:

kvlrn:

I've known a couple people who had to take heparin instead. Could you see if your RE can prescribe that instead of lovenox? Heparin should be covered by your insurance and its just as effective.

I asked about this but they said they'd really prefer to not switch me at this point, since I've been on Lovenox for a month now. It would be a last resort but I think I'd be uncomfortable with that and the potential concerns and just suck it up and pay for the Lovenox OOP.  

That seems unfair of him to ask that of you. You shouldn't have to pay out of pocket when there's a cheaper alternative out there for you. Good luck! I hope it all works out for you!

RondackHiker

kvlrn:

RondackHiker:

CrisM022:

Why is insurance denying it if your doctor says it is necessary? I had some issues last time and I called HR. They were able to help as well.

Because insurance companies suck? When I delivered my first via c-section, my insurance happily paid for the c-section but refused to pay for the anesthesia. They felt my spinal was 'unnecessary' despite what my doctor said (and common sense would dictate) and wouldn't pay.

They also didn't pay DS's NICU bill, but that's another story. 

That's bull crap. How is a spinal "unnecessary"??? Or do they not know that regional anesthesia is preferred over general for the wellbeing of the baby? We generally like babies to BREATHE when they are born! Or maybe they would pay for you to bite down on a rag instead. That makes me mad for you!

When my husband was talking to them he actually asked if they'd have paid for a flucking stick for me to bite down on. That was about an hour into the call. We gave up after that. I am so glad we don't have that insurance anymore. 

Madelyn0713

kvlrn:

Madelyn0713:

kvlrn:

I've known a couple people who had to take heparin instead. Could you see if your RE can prescribe that instead of lovenox? Heparin should be covered by your insurance and its just as effective.

I asked about this but they said they'd really prefer to not switch me at this point, since I've been on Lovenox for a month now. It would be a last resort but I think I'd be uncomfortable with that and the potential concerns and just suck it up and pay for the Lovenox OOP.  

That seems unfair of him to ask that of you. You shouldn't have to pay out of pocket when there's a cheaper alternative out there for you. Good luck! I hope it all works out for you!

They aren't asking me to do that. They said it wouldn't be their preference, which is why they are appealing again, but they would at a last resort. I said I wouldn't be comfortable with the change and would pay OOP to decrease any chance of potential complications.  

TessyMessy

Fingers Crossed for your second appeal! Insurance companies are the worst!

TicaAngel00

What a pain in the butt! It never ceases to amaze me how much these insurance companies can't think outside of their arses just to save money. 

I had this talk last night with our preggo cousin who has a PPO; we have an HMO with Kaiser. It's just ridiculous.

Sending lots of positive thoughts your way that the appeal favors you this time. 

puppies&rainbows13

Hi -

 

I wanted to share this link with you.  Sanofi (makers of Lovenox) does offer patient assistance programs to reduce or eliminate the cost of the drug in these situations.  I personally do not prescribe this specific drug so I am not familiar with this assistance program , but I use other drug companies programs just like this one when one of my patient's cannot get a prescription I believe is necessary for them and coverage is denied.  Even if your income is relatively good you may still qualify for at least some help with the cost.  

 https://www.sanofi.us/l/us/en/layout.jsp?scat=FA582E76-C4AF-453B-BE47-228829600888

 

JennyT90

I was a pharmacy technician at a retail pharmacy for over 4 and a half years and it never ceased to amaze me how much insurance companies control what you can and cannot take. How an insurance company can decide that something that your doctor says is necessary actually isn't has never been a concept I could grasp. It all comes down to the holy dollar.

I truly hope that your second appeal works. I know how frustrating this kind of thing can be from both ends. Also, as a last resort, you can try to contact the company that makes Lovenox. Once in a while they will have something that can help you pay for it. (Whether a monthly coupon or a program to help with costs.) Also, ask the employees at your pharmacy if there are any discount programs in your area. While I was working at the pharmacy we had a couple different programs available and some would cover 70-80% of the cost. (Of course some would only cover $5 so it completely depended on the medication.) It's worth a shot, however, I hope it's not necessary and everything works out for you!