Guest guest Posted May 16, 2007 Report Share Posted May 16, 2007 I had a similar issue with my insurance company. After taking Humira weekly for six months, in February the insurance company decided it needed to do a " Re-authorization review " . I found out when I called to refill the prescription, and couldn't get the meds. It took almost two months for the review (and no Humira during that time), and then they only authorized every other week, half what I was taking. My rheumy appealed for me, and we finally got the ok to go back to once a week. That was last week - over three months after they arbitrarily decided to second guess my doctor! It's downright frightening the power the insurance companies have over us. Now, today, UPS was supposed to deliver the meds, but no sign of them so far. Looks like they screwed up again. I've put in one phone call, time to call again and see where their id**t driver is. On 5/16/07, Kate Guynn <kguynn@...> wrote: > > From the insurance stupid files! My doctor decided to switch me over to > > the injectable MTX. We also raise from 6-7 per week. I've been short on > money so I waited a week before sending off my new RX to CareMark. I upped > > the dose with pills I had on hand and was nauseous for a day last > week. That's the norm for me. Yesterday I was checking on-line and showed > that the RX order was cancelled. So I called. I was told that " our plan > doesn't cover that delivery form " , you must be kidding! They are sending > me a form to give to my doctor stating that it is medically necessary. Gee > > I thought the fact that my doctor wrote an RX would mean that it's > medically necessary! > > Kate G > AS > Hashi's > > > -- South Pasadena, CA You can see my galleries at http://www.pbase.com/arenared986 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2007 Report Share Posted May 16, 2007 I know when my re-authorization for Remicade is(August), my doctor has written it all over my paperwork so she starts earlier on it. It is crazy how much power they have! Kate G AS Hashi's At 04:45 PM 5/16/2007, you wrote: >I had a similar issue with my insurance company. After taking Humira weekly >for six months, in February the insurance company decided it needed to do a > " Re-authorization review " . I found out when I called to refill the >prescription, and couldn't get the meds. It took almost two months for the >review (and no Humira during that time), and then they only authorized every >other week, half what I was taking. My rheumy appealed for me, and we >finally got the ok to go back to once a week. That was last week - over >three months after they arbitrarily decided to second guess my doctor! It's >downright frightening the power the insurance companies have over us. > >Now, today, UPS was supposed to deliver the meds, but no sign of them so >far. Looks like they screwed up again. I've put in one phone call, time to >call again and see where their id**t driver is. > >On 5/16/07, Kate Guynn <kguynn@...> wrote: > > > > From the insurance stupid files! My doctor decided to switch me over to > > > > the injectable MTX. We also raise from 6-7 per week. I've been short on > > money so I waited a week before sending off my new RX to CareMark. I upped > > > > the dose with pills I had on hand and was nauseous for a day last > > week. That's the norm for me. Yesterday I was checking on-line and showed > > that the RX order was cancelled. So I called. I was told that " our plan > > doesn't cover that delivery form " , you must be kidding! They are sending > > me a form to give to my doctor stating that it is medically necessary. Gee > > > > I thought the fact that my doctor wrote an RX would mean that it's > > medically necessary! > > > > Kate G > > AS > > Hashi's > > > > > > > > > >-- > >South Pasadena, CA >You can see my galleries at http://www.pbase.com/arenared986 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2007 Report Share Posted May 16, 2007 I thought mine was supposed to be annual - guess they can do it any time they want. On 5/16/07, Kate Guynn <kguynn@...> wrote: > > I know when my re-authorization for Remicade is(August), my doctor has > written it all over my paperwork so she starts earlier on it. It is crazy > how much power they have! > > Kate G > AS > Hashi's > > At 04:45 PM 5/16/2007, you wrote: > >I had a similar issue with my insurance company. After taking Humira > weekly > >for six months, in February the insurance company decided it needed to do > a > > " Re-authorization review " . I found out when I called to refill the > >prescription, and couldn't get the meds. It took almost two months for > the > >review (and no Humira during that time), and then they only authorized > every > >other week, half what I was taking. My rheumy appealed for me, and we > >finally got the ok to go back to once a week. That was last week - over > >three months after they arbitrarily decided to second guess my doctor! > It's > >downright frightening the power the insurance companies have over us. > > > >Now, today, UPS was supposed to deliver the meds, but no sign of them so > >far. Looks like they screwed up again. I've put in one phone call, time > to > >call again and see where their id**t driver is. > > > >On 5/16/07, Kate Guynn <kguynn@... <kguynn%40teamkaos.org>> > wrote: > > > > > > From the insurance stupid files! My doctor decided to switch me over > to > > > > > > the injectable MTX. We also raise from 6-7 per week. I've been short > on > > > money so I waited a week before sending off my new RX to CareMark. I > upped > > > > > > the dose with pills I had on hand and was nauseous for a day last > > > week. That's the norm for me. Yesterday I was checking on-line and > showed > > > that the RX order was cancelled. So I called. I was told that " our > plan > > > doesn't cover that delivery form " , you must be kidding! They are > sending > > > me a form to give to my doctor stating that it is medically necessary. > Gee > > > > > > I thought the fact that my doctor wrote an RX would mean that it's > > > medically necessary! > > > > > > Kate G > > > AS > > > Hashi's > > > > > > > > > > > > > > > > >-- > > > >South Pasadena, CA > >You can see my galleries at http://www.pbase.com/arenared986 > -- South Pasadena, CA You can see my galleries at http://www.pbase.com/arenared986 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2007 Report Share Posted May 17, 2007 Kate Guynn wrote: > > From the insurance stupid files! <snip>They are sending > me a form to give to my doctor stating that it is medically necessary. > Gee > I thought the fact that my doctor wrote an RX would mean that it's > medically necessary! > I'm going through the same thing with my insurance company over my osteoporosis medication. All I did was change pharmacies because that particular med is supposed to be refrigerated and the pharmacy I was using was not keeping it cold. I called the manufacturer and they said the reason the med wasn't working for me was because it's shipped on dry ice and should be kept cold continually. The pharmacy was giving it to me warm and refused to refrigerate it. Said it was okay to let it get warm until the first time you use it. That's when I called the manufacturer. So I switched pharmacies with a new prescription from the doctor so maybe this expensive med ($610 a month without insurance) would work. Now the insurance company isn't sure if they are going to approve it or not. I've been waiting 10 days and so far, they haven't. It's frustrating! Nina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 >I'm going through the same thing with my insurance company over my >osteoporosis medication. All I did was change pharmacies because that >particular med is supposed to be refrigerated and the pharmacy I was >using was not keeping it cold. I called the manufacturer and they said >the reason the med wasn't working for me was because it's shipped on dry >ice and should be kept cold continually. The pharmacy was giving it to >me warm and refused to refrigerate it. Said it was okay to let it get >warm until the first time you use it. That's when I called the >manufacturer. So I switched pharmacies with a new prescription from the >doctor so maybe this expensive med ($610 a month without insurance) >would work. Now the insurance company isn't sure if they are going to >approve it or not. I've been waiting 10 days and so far, they haven't. >It's frustrating! > >Nina WOW that's crazy! If it's a national pharmacy, I'd contact the corporate office and advise them what happened. Kate G AS Hashi's Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 > WOW that's crazy! If it's a national pharmacy, I'd contact the corporate > office and advise them what happened. I tried again yesterday afternoon late to see if they had approved the med or not and the pharmacy said it still wouldn't go through. So I called the insurance company and they said it has to be done through a specialty pharmacy. Weird that wasn't the case last refill or the whole year I took it. So I contacted the doctor's office and they called the specialty pharmacy for me. The pharmacy in turn contacted me this morning and they are shipping it on Monday. Why the change in which pharmacy can fill it and why I wasn't notified by the insurance company when they approved it? I have no clue!! Nina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 I'd defiantly contact the corporate office of the first one that wasn't keeping it refrigerated.... But yes, that's crazy! Kate At 11:53 AM 5/18/2007, you wrote: >I tried again yesterday afternoon late to see if they had approved the >med or not and the pharmacy said it still wouldn't go through. So I >called the insurance company and they said it has to be done through a >specialty pharmacy. Weird that wasn't the case last refill or the >whole year I took it. So I contacted the doctor's office and they >called the specialty pharmacy for me. The pharmacy in turn contacted >me this morning and they are shipping it on Monday. Why the change in >which pharmacy can fill it and why I wasn't notified by the insurance >company when they approved it? I have no clue!! > >Nina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 (((((((Nina))))))) I am sorry for the stuggle you have had with the pharmacy - I'd at least let the insurance company know they need to communicate with you better.... It's very frustrating to have something like that happen! rose Nina <ncampbell@...> wrote: --- In , Kate Guynn <kguynn@...> wrote: > WOW that's crazy! If it's a national pharmacy, I'd contact the corporate > office and advise them what happened. I tried again yesterday afternoon late to see if they had approved the med or not and the pharmacy said it still wouldn't go through. So I called the insurance company and they said it has to be done through a specialty pharmacy. Weird that wasn't the case last refill or the whole year I took it. So I contacted the doctor's office and they called the specialty pharmacy for me. The pharmacy in turn contacted me this morning and they are shipping it on Monday. Why the change in which pharmacy can fill it and why I wasn't notified by the insurance company when they approved it? I have no clue!! Nina --------------------------------- Got a little couch potato? Check out fun summer activities for kids. --------------------------------- Need Mail bonding? Go to the Q & A for great tips from Answers users. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2007 Report Share Posted May 20, 2007 Kate Guynn wrote: > > >I'd defiantly contact the corporate office of the first one that wasn't > keeping it refrigerated.... > That one was a hometown pharmacy. I'm still debating on what I should do about it. Eli Lilly said if the pharmacist had any argument about whether it was to be refrigerated or not, have him contact them (he had already argued with me about it when I brought it up to him). I think he at least owes me the $2400 I spent out of my own pocket for the year I took it that it didn't work because it wasn't refrigerated. The first two months I had to pay the whole thing because I didn't have insurance ($610 per month) then a big co-pay every month after that. You can only take the med for two years and I wasted a whole year of that. I worry about his other customers. Most are elderly. I bet they never check their meds. In fact one time he gave me the wrong med (a different prescription) and I immediately took it back. He said he wished all his customers would check their meds when they get home. I really think he's negligent and I worry about those elderly customers that either wouldn't think to check their meds every time they get them or have known him for many years and don't want to kick up a fuss. Nina Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2007 Report Share Posted May 21, 2007 File a complaint with the BBB and the State Board. Kate At 12:40 PM 5/20/2007, you wrote: >That one was a hometown pharmacy. I'm still debating on what I should >do about it. Eli Lilly said if the pharmacist had any argument about >whether it was to be refrigerated or not, have him contact them (he had >already argued with me about it when I brought it up to him). I think >he at least owes me the $2400 I spent out of my own pocket for the year >I took it that it didn't work because it wasn't refrigerated. The >first two months I had to pay the whole thing because I didn't have >insurance ($610 per month) then a big co-pay every month after that. >You can only take the med for two years and I wasted a whole year of that. > >I worry about his other customers. Most are elderly. I bet they never >check their meds. In fact one time he gave me the wrong med (a >different prescription) and I immediately took it back. He said he >wished all his customers would check their meds when they get home. I >really think he's negligent and I worry about those elderly customers >that either wouldn't think to check their meds every time they get them >or have known him for many years and don't want to kick up a fuss. > >Nina Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.