Re: Getting Medications Paid for

[Guest guest]

Cheryl wrote:

>

> If the insurance is simply sitting on it, I'd be on the phone four times a day

to the insurance company demanding that they process my paperwork. That's the

only way you're going to get them to move quickly enough - harass them!

>

> If they've denied it, then you need to go back to your doctor to get him to

rewrite his appeal, because he needs to take responsibility for figuring out

exactly how to fill out the form correctly.

>

> I've appealed a lot of drugs in my day, and it's often taken me sitting on the

phone with the insurance company, demanding to speak to a manager, then to speak

to their boss, then to speak to their boss before they got off their duffs and

did their job.

>

> The " squeaky wheel gets the grease, " as they say.

All, Amen to Cheryl !

I agree with Cheryl, I have had Walgreen state, you insurance denied this and I

ask why and they say , " We don't know " . Well, I call and its always something

stupid. I always ask the pharmacy to call back and ask for an override (key word

pharmacy and insurance use) until we find out what they want and EVERY TIME , I

get it.

Also, you can ask for vacation dispensing if you need an early refill to go out

of town. I have had to do this several times to go care for my Dad. It is never

earlier than five days though.

Learn what section of your insurance/pharmacy contractor does the approval, such

as approval department, ask for that and get to know ONE specific person

especially a case manager or supervisor that will tell you the justification

needed for a medication.

Well being of the patient is an old usage and they want specifics, like used for

a sleep disorder and has had: sleep study with sleep specialist etc etc

My Dad has to get justification for his heart medications and our pharmacy

contractor, Express Script has the forms online for justification of all the

medications that need prior approval.

Get to know these and visit your insurance's website and contacts.

It is lifesaver, do not depend on your Doctors office nurse to be calling, I

always tell them, I will call and bug them and call you back with what we need.

It is essential patients know these things as someday, if you need a medication

that requires this process, it is better to do it yourself and learn about the

process.

You will get it approved quicker and the will assist you more promptly.

I got reimbursement on the month I paid for my provigil as they had option that

they would pay for thirty days before while seeking approval.

Good Luck.

Bennie