My Insurance Company

[Vampy]

I have never had problems with getting my perscriptions filled i go in and grab them sign and leave..Unless they shut off my insurance..but i have it back. i figured it would be like every other time, run in grab the bags and sign for them and go home. i had to wait a hour...they wouldnt cover my pulmacourt, and they wouldnt allow me to have the 660 pills of Ultrase MT20 my doctor prescribed me said it was to many i could only have the 500. which will only last me 20 days.

Anyone have this problem?? what can i do to fix it. im new at this whole thing and i dunno what to do

 

[Jane]

It depends a lot on your insurance, but we've had this problem with certain meds too. We go to pick up our meds and they say we need a prior authorization from the doctor. <i>Isn't a prescription already prior authorization?</i>

We then have to call the insurance company, have them fax and auth. form to the doctor, then call the doctor to explain the problem and have her send it back. Meanwhile it could take several days for you to get the medicine. Doesn't make any sense.

 

[JazzysMom]

Is this insurance an HMO? I remember hearing of a family whose 2 kids with CF were limited to the amount of enzymes allowed. I know for me that my doctor does an appeal if my meds arent covered or even if they are at a higher co pay etc because its not on the formulary list. CFers often require meds that cant be generic or need to be dispensed "oddly" compared to other patients. We get lost in the "normal" procedure. Why you are having a fight now I dont know, but there should be a way to get around it!

 

[NoExcuses]

Go on your insurance's website and print off a prior authorization form.

Each insurance has a formulary list of meds that they will and will not cover. Pulmicort may not be on their formulary list. But that's OK. If your doc submits a prior authorization form with verbiage saying that pulmicort keeps you out of the hospital (good thing to say cuz hospital stays are very costly for insurance companies so they are motivated to KEEP YOU OUT OF THE HOSPITAL).

Same thing with your Ultrase. Get another prior auth form. Have you doc say that nutrition is important for not getting lung infections. If you get a lung infection, you will be in the HOSPITAL. Your pancreatic insufficiency requires you to take X amoutn of Ultrase per meal. you eat X amounts of meals a day. Therefore, you need X amount of the pills.

Hope this helps <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[folione]

We ran into the problem with enzymes quantity once. The insurance co. did their calculation of dosage and said the Dr. was prescribing WAY too much for a 30 day supply. The CF nurse called the insurance co. and the Rx got filled as written. I don't know what she said to them.