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Medical Forum / Diseases and Disorders / Arthritis / March 2008Problems Getting Insurance to Approve Meds
A number of people have been expressing that they are having a hard time getting their insurance to pay for certain medications. I was talking to my sister this morning, who is a medical claims processor, and she reminded me of something that bears mentioning. Employers actually make many of the policy level decisions of what will be covered and what won't. For example, the employer decides whether to cover vitamins and what restrictions to place on prescription meds. This is all part of controlling their costs. In addition, since the employer is the actual customer of the insurance company, their input and complaints carry far more weight than the patients. So, if you are having trouble getting a prescription drug covered, it might be helpful to talk to your boss or HR department. Something to think about. Walt Thanks Walt, that is good information. I am in a managed care program with Blue Cross for Medicare and after a lot of talking back and forth, I found out that their drug formulary follows that of Medicare. If it's not covered by Medicare they don't cover it either. The next step is to file a protest with Medicare and my endocrinologist doctor doesn't seem to want to bother. Ann Ann, You could still try filing an appeal on your own with medicare. You just never know, they might give in with the appeal. . . . . Donna . . . . 1.) ANGELS EXIST, but some times, since they don't all have wings, we call them FRIENDS...... 2.) J.K.M.A. > Thanks Walt, that is good information. I am in a managed care program > with Blue Cross for Medicare and after a lot of talking back and forth, [quoted text clipped - 3 lines] > to want to bother. > Ann I found that most doctors can't be bothered since they are not having to shell out the money. When I told my PCP that I couldn't afford all the tests she wanted me to have, she looked at me like I had six heads. I think they think we are all made of money. I asked her how she would like living on $1300 a month? She didn't answer. I'm going to switch my health care provider when we can do that in December. I have Unicare now and they leave a lot to be desired. Between them and Medicare, I'm paying $158 a month. Carole >> Thanks Walt, that is good information. I am in a managed care program >> with Blue Cross for Medicare and after a lot of talking back and forth, [quoted text clipped - 15 lines] > > Carole So true,,,, I got the same reaction from my RD when I agreed with him that Enbrel works best for me but I want to take Arava because it had gone generic and was in the range I could pay for when my insurance ends. So it goes. Harv > So true,,,, I got the same reaction from my RD when I agreed with him that > Enbrel works best for me but I want to take Arava because it had gone > generic and was in the range I could pay for when my insurance ends. > So it goes. > Harv I know how you feel, Harv. I have to take Coreg for my heart and it just went generic. So now I get to pay $4 at Walmart instead of $60 to Walgreens! YAY!!!!!!!!!!!!!!!!!! :-))) Carole
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