Why would my insurance denial pullmozyme for our son?

S

SARAHSARAH253

New member
Today we just started our new chapter on CF the use of a nebulizer. It was a tough day at the CF Clinic, chest e-rays are no fun for a little baby. All the feelings from months back came rushing back as my baby cried, as the held the mask to his bright red face. I felt sick all afternoon, as my baby slept. I guess the reality of the CF kicked in a little more today. I got home and my husband went to pick up his new prescriptions. Another reality kicked in the pharmacy wanted $2,000. For the pullmozyme I need to put into his nebulizer. I called the insurance company they said it's too late in the afternoon to resolve this and to call back in the morning. Why would they say no? What should I do other than, call and demand answers for this?

Thanks

Sarah

Mommmy to Johnny 6months w/cf
 
S

SARAHSARAH253

New member
Today we just started our new chapter on CF the use of a nebulizer. It was a tough day at the CF Clinic, chest e-rays are no fun for a little baby. All the feelings from months back came rushing back as my baby cried, as the held the mask to his bright red face. I felt sick all afternoon, as my baby slept. I guess the reality of the CF kicked in a little more today. I got home and my husband went to pick up his new prescriptions. Another reality kicked in the pharmacy wanted $2,000. For the pullmozyme I need to put into his nebulizer. I called the insurance company they said it's too late in the afternoon to resolve this and to call back in the morning. Why would they say no? What should I do other than, call and demand answers for this?

Thanks

Sarah

Mommmy to Johnny 6months w/cf
 
S

SARAHSARAH253

New member
Today we just started our new chapter on CF the use of a nebulizer. It was a tough day at the CF Clinic, chest e-rays are no fun for a little baby. All the feelings from months back came rushing back as my baby cried, as the held the mask to his bright red face. I felt sick all afternoon, as my baby slept. I guess the reality of the CF kicked in a little more today. I got home and my husband went to pick up his new prescriptions. Another reality kicked in the pharmacy wanted $2,000. For the pullmozyme I need to put into his nebulizer. I called the insurance company they said it's too late in the afternoon to resolve this and to call back in the morning. Why would they say no? What should I do other than, call and demand answers for this?

Thanks

Sarah

Mommmy to Johnny 6months w/cf
 
S

SARAHSARAH253

New member
Today we just started our new chapter on CF the use of a nebulizer. It was a tough day at the CF Clinic, chest e-rays are no fun for a little baby. All the feelings from months back came rushing back as my baby cried, as the held the mask to his bright red face. I felt sick all afternoon, as my baby slept. I guess the reality of the CF kicked in a little more today. I got home and my husband went to pick up his new prescriptions. Another reality kicked in the pharmacy wanted $2,000. For the pullmozyme I need to put into his nebulizer. I called the insurance company they said it's too late in the afternoon to resolve this and to call back in the morning. Why would they say no? What should I do other than, call and demand answers for this?

Thanks

Sarah

Mommmy to Johnny 6months w/cf
 
S

SARAHSARAH253

New member
Today we just started our new chapter on CF the use of a nebulizer. It was a tough day at the CF Clinic, chest e-rays are no fun for a little baby. All the feelings from months back came rushing back as my baby cried, as the held the mask to his bright red face. I felt sick all afternoon, as my baby slept. I guess the reality of the CF kicked in a little more today. I got home and my husband went to pick up his new prescriptions. Another reality kicked in the pharmacy wanted $2,000. For the pullmozyme I need to put into his nebulizer. I called the insurance company they said it's too late in the afternoon to resolve this and to call back in the morning. Why would they say no? What should I do other than, call and demand answers for this?
<br />
<br />Thanks
<br />
<br />Sarah
<br />
<br />Mommmy to Johnny 6months w/cf
 
P

paysmom

New member
we just started pulmozyme 3 months ago I also was told the exact same thing as you were. We had the nurse from clinic call after I was getting no where and she got it covered in about three days. I hope they get it covered for you we were shocked when they told me I had to pay almost $2000. I would call them and also have the nurse call.
 
P

paysmom

New member
we just started pulmozyme 3 months ago I also was told the exact same thing as you were. We had the nurse from clinic call after I was getting no where and she got it covered in about three days. I hope they get it covered for you we were shocked when they told me I had to pay almost $2000. I would call them and also have the nurse call.
 
P

paysmom

New member
we just started pulmozyme 3 months ago I also was told the exact same thing as you were. We had the nurse from clinic call after I was getting no where and she got it covered in about three days. I hope they get it covered for you we were shocked when they told me I had to pay almost $2000. I would call them and also have the nurse call.
 
P

paysmom

New member
we just started pulmozyme 3 months ago I also was told the exact same thing as you were. We had the nurse from clinic call after I was getting no where and she got it covered in about three days. I hope they get it covered for you we were shocked when they told me I had to pay almost $2000. I would call them and also have the nurse call.
 
P

paysmom

New member
we just started pulmozyme 3 months ago I also was told the exact same thing as you were. We had the nurse from clinic call after I was getting no where and she got it covered in about three days. I hope they get it covered for you we were shocked when they told me I had to pay almost $2000. I would call them and also have the nurse call.
 
M

Mommafirst

Guest
I don't know why exactly, as we just started pulmozyme and we got a free month from genzyme (check into this with your cf nurse, btw). I'm guessing its a drug that needs a pre-authorization or because its a specialty drug (CF specifiic) your insurance company may require you to use their mail order pharmacy instead of a local one. I'm pretty sure ours requires both of those things to have the med approved.

I'm sorry it was such a tough CF day. This disease sucks! HUGS!!!
 
M

Mommafirst

Guest
I don't know why exactly, as we just started pulmozyme and we got a free month from genzyme (check into this with your cf nurse, btw). I'm guessing its a drug that needs a pre-authorization or because its a specialty drug (CF specifiic) your insurance company may require you to use their mail order pharmacy instead of a local one. I'm pretty sure ours requires both of those things to have the med approved.

I'm sorry it was such a tough CF day. This disease sucks! HUGS!!!
 
M

Mommafirst

Guest
I don't know why exactly, as we just started pulmozyme and we got a free month from genzyme (check into this with your cf nurse, btw). I'm guessing its a drug that needs a pre-authorization or because its a specialty drug (CF specifiic) your insurance company may require you to use their mail order pharmacy instead of a local one. I'm pretty sure ours requires both of those things to have the med approved.

I'm sorry it was such a tough CF day. This disease sucks! HUGS!!!
 
M

Mommafirst

Guest
I don't know why exactly, as we just started pulmozyme and we got a free month from genzyme (check into this with your cf nurse, btw). I'm guessing its a drug that needs a pre-authorization or because its a specialty drug (CF specifiic) your insurance company may require you to use their mail order pharmacy instead of a local one. I'm pretty sure ours requires both of those things to have the med approved.

I'm sorry it was such a tough CF day. This disease sucks! HUGS!!!
 
M

Mommafirst

Guest
I don't know why exactly, as we just started pulmozyme and we got a free month from genzyme (check into this with your cf nurse, btw). I'm guessing its a drug that needs a pre-authorization or because its a specialty drug (CF specifiic) your insurance company may require you to use their mail order pharmacy instead of a local one. I'm pretty sure ours requires both of those things to have the med approved.
<br />
<br />I'm sorry it was such a tough CF day. This disease sucks! HUGS!!!
 
A

Alyssa

New member
It's most likely because of the expense -- it is a drug that needs pre-authorization before they will fill the Rx. It is usually just a matter of a fax or a nurse answering a few questions, then they will have the pre-auth on file and you won't have any problems again until this time next year when they will want to do the same thing.

Your doctors office will most likely be familiar with the drill.... just tell your insurance company to do whatever they need (send a fax or call)... I'm sure you can get it resolved in a day or two.
 
A

Alyssa

New member
It's most likely because of the expense -- it is a drug that needs pre-authorization before they will fill the Rx. It is usually just a matter of a fax or a nurse answering a few questions, then they will have the pre-auth on file and you won't have any problems again until this time next year when they will want to do the same thing.

Your doctors office will most likely be familiar with the drill.... just tell your insurance company to do whatever they need (send a fax or call)... I'm sure you can get it resolved in a day or two.
 
A

Alyssa

New member
It's most likely because of the expense -- it is a drug that needs pre-authorization before they will fill the Rx. It is usually just a matter of a fax or a nurse answering a few questions, then they will have the pre-auth on file and you won't have any problems again until this time next year when they will want to do the same thing.

Your doctors office will most likely be familiar with the drill.... just tell your insurance company to do whatever they need (send a fax or call)... I'm sure you can get it resolved in a day or two.
 
A

Alyssa

New member
It's most likely because of the expense -- it is a drug that needs pre-authorization before they will fill the Rx. It is usually just a matter of a fax or a nurse answering a few questions, then they will have the pre-auth on file and you won't have any problems again until this time next year when they will want to do the same thing.

Your doctors office will most likely be familiar with the drill.... just tell your insurance company to do whatever they need (send a fax or call)... I'm sure you can get it resolved in a day or two.
 
A

Alyssa

New member
It's most likely because of the expense -- it is a drug that needs pre-authorization before they will fill the Rx. It is usually just a matter of a fax or a nurse answering a few questions, then they will have the pre-auth on file and you won't have any problems again until this time next year when they will want to do the same thing.
<br />
<br />Your doctors office will most likely be familiar with the drill.... just tell your insurance company to do whatever they need (send a fax or call)... I'm sure you can get it resolved in a day or two.
 
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