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Medical Forum / Diseases and Disorders / Arthritis / March 2008lidoderm patch and insurance
If you remember, I got my pcp to prescribe lidoderm patches for me last week. Went to pick them up and was told insurance had to pre-approve them even though it is a covered med under my plan. Found out today that they refuse to grant coverage for them because I don't have shingles! pcp is looking into something else that will do a similar job. garyz So now the insurance company gets to decide which medication will work best for you?! *stalks off, muttering under her breath* Kelly C. > If you remember, I got my pcp to prescribe lidoderm patches for me last > week. Went to pick them up and was told insurance had to pre-approve them > even though it is a covered med under my plan. Found out today that they > refuse to grant coverage for them because I don't have shingles! > pcp is looking into something else that will do a similar job. > garyz I am so angry with my insurance company that your post really makes me steam. Mine has denied coverage twice now for a med that costs $286.99 for 30 pills. They claim the doctor could order something else, but the doctor says there isn't anything else. Some clerk in an insurance company overides the doctors decisions. <end of rant> Ann >I am so angry with my insurance company that your post really makes me > steam. Mine has denied coverage twice now for a med that costs $286.99 > for 30 pills. They claim the doctor could order something else, but the > doctor says there isn't anything else. Some clerk in an insurance > company overides the doctors decisions. <end of rant> > Ann I know the feeling. Not a med but my doctor ordered a nuclear stress test, not a treadmill test after he found a weakness on the left side of my heart. The insurance company denied it. He said not to even appeal (I guess figuring it'd be a waste of time). But each time I visit him, he says "If anything happens, you can sue them." Thanks, Doc! He wanted the nuclear test because, according to him, it's less subject to error (false positive, necesitating more tests, false negative, not getting needed additional testing). If it wasn't for the scramble in the half dozen doctors I see, I'd change insurance. Maybe I'll change doctors. At one time I planned to (after his saying not to appeal) but so far, I haven't. Nell Nell, I'm really surprised that your insurance wouldn't approve and pay for the stress test that your doctor ordered, especially since you have lung disease. They usually always pay for the test to be done the way your doctor ordered it with lung patients! . . . . Donna . . . . 1.) ANGELS EXIST, but some times, since they don't all have wings, we call them FRIENDS...... 2.) J.K.M.A. Gary, Sorry to hear you haven't gotten hold of the patches yet to try out. Sure hope your insurance will approve them for you. I checked my insurance coverage on the patches this afternoon after reading your post. Thankfully, my insurance will cover them without a problem. I plan on asking my rheumatologist for a prescription on monday of next week when I see him. Hope you can get those patches soon!!! . . . . Donna . . . . 1.) ANGELS EXIST, but some times, since they don't all have wings, we call them FRIENDS...... 2.) J.K.M.A. > Gary, > [quoted text clipped - 15 lines] > Donna > . Hi Donna, I checked for coverage too before requesting them. Web says they are a covered med. What it doesn't say is under what conditions it is a covered med. On another note, I see the neurosurgeon this morning to go over what options I have with my lumbar ddd. Golfing is an option, golfing is an option, golfing is an option,..... :-) GaryZ Gary what is the diagnosis the doctor used to get you that prescription. Maybe call your insurance and see if there is special "circumstance" that they consider it ok to pay for them? Just because shingles is one of them doesn't mean it is just that one. I never heard of them used for shingles but who am I? I use them for back pain as well as muscle pain sometimes. All over pain for that matter, you can cut them up. Call the insurance and see what they ok. MERCK MEDCO ok's them. hope you get them somehow janers > Gary > what is the diagnosis the doctor used to get you that prescription. Maybe call your insurance and [quoted text clipped - 9 lines] > > janers I was told by my PCP *not* to use my Lidoderm patches on my shingles (I get them for the RA/OA/Bursitis in my knees). He just gave me a steroid ointment that wiped out the itching and the burning pain. That was enough for me. Cant' remember why he said that I shouldn't use them on my shingles (that keep coming back, danggit, right under the bra under the left arm), but he was very specific. Smokie Darling (Annie) Hi Anne, ...and that "something else" would be? according to them?? garyz >I am so angry with my insurance company that your post really makes me > steam. Mine has denied coverage twice now for a med that costs $286.99 > for 30 pills. They claim the doctor could order something else, but the > doctor says there isn't anything else. Some clerk in an insurance > company overides the doctors decisions. <end of rant> > Ann Gary, It's almost funny when I talk to the insurance folks. You can tell they have no clue. There is no substitute for this particular med called Zemplar. They also denied my vitamin D which is prescription strength 50,000 iu twice a week. They say I can get it over the counter in lesser dosages. What I can't get through to them is I would have to spend my whole week swallowing pills to equal the dosage I'm supposed to have. It's easier to just pay for it since it's only 8 pills per month. I really wish you luck with the insurance mess. Could they be trying to kill us off with extreme stress? That would save money and add to their profits. Just remember, your estate can sue them when your dead! :-( garyz > Gary, > It's almost funny when I talk to the insurance folks. You can tell they [quoted text clipped - 8 lines] > kill us off with extreme stress? That would save money and add to their > profits. That's incredible. What insurance company do you have? I am on Federal BC/BS and they have never sweated me on Lideoderm, Humira, or anything besides Nexium. Even that they covered after a call from my doc. I guess I am lucky. Walt > If you remember, I got my pcp to prescribe lidoderm patches for me last > week. Went to pick them up and was told insurance had to pre-approve them > even though it is a covered med under my plan. Found out today that they > refuse to grant coverage for them because I don't have shingles! > pcp is looking into something else that will do a similar job. > garyz State of Illinois is basically self insured, but it is administered by Medco and Health Alliance HMO. I've never been denied a medication before. May have had to pay a huge co-pay for certain meds depending how they fall into the tier, but not outright denied. The state is financially in big trouble right now and that may have some bearing on the situation. Perhaps "initial denial" policy and approval upon appeal. Who knows? Doc is supposedly looking into an alternative. Watch them approve the alternative and have it cost them more than the lidoderm would have! Are governments supposed to make sense? ever? :-) GaryZ > That's incredible. What insurance company do you have? > [quoted text clipped - 10 lines] >> pcp is looking into something else that will do a similar job. >> garyz Gary, I noticed when I was checking into whether or not my insurance would cover the lidoderm patches, that there is lidocain cream, lotion, powder, etc. so other forms that might work? Maybe your doctor can get another form approved for you to use??? I don't know how effective they would be, as I didn't even know there were so many forms out there. . . . . Donna . . . . 1.) ANGELS EXIST, but some times, since they don't all have wings, we call them FRIENDS...... 2.) J.K.M.A.
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