Re: mitoldies: insurance woes - Case Managers

[Guest guest]

I can't stress enough the need for each member of this list to get a case

manager. The case manager works for you with the insurance companies. If you

don't have one - make it your first priority on Monday. You won't believe the

difference this can make.

Carnitor should be covered by you insurance as long as it's written in

prescription form. I can understand the problem with CoQ as there just aren't

many who can get this covered but Carnitor should not be denied.

Alice

Re: : insurance woes

,

What reason do they give for denying the carnitor? I can't

understand it.

Another option may be find out if the drug company will provide you

with a discount on the drugs, directly. I was told by a lady that

worked in a doctor's office (her job was to help patients get free

medication from the drug companies) - that if you don't have a

prescription plan, you may qualify for free medication. You need to

ask the nurses (not the doctors) about the patient assistant

program, as often the doctors don't know anything about it.

I'm also very frustrated with insurance companies. I am insured

with Fortis, which is one of the larger companies that handles a lot

of people who are self employed. I am amazed at how the insurance

companies are so blatantly sticking it to us these days. They raise

our premiums (I just got another BIG increase this week) until we

can no longer afford it -- and at the same time, they create

different products (policies) which are more affordable and only

offer them to their " healthy " policyholders.

Eventually everyone with a health issue will be forced to drop their

insurance because of lack of affordability (a great way for the

insurance companies to keep their costs down -- by weeding out the

sick).

It shouldn't be legal. I was told by my agent that the only real

option I have is to go to state insurance (HMO) where they have to

accept me. Unfortunately, it severely limits my choice of doctors

that I can see (hard enough to find a doctor on a large PPO plan,

I'm not sure how you that have to - are finding the right doctors on

restricted HMOs).

Maggie

> well looks as if I wont be getting any relief anytime soon.

> My insurance wont cover carnitor and I cant afford COQ10.

> the insurance also refuses to cover my kids pancreatic enzymes. I

have

> appealed and so has the docs, still getting denials. frustrating.

you would think

> they would rather cover the drugs then the doc visits it might

save.

>

>

[Guest guest]

If any of you take folic acid, that can be written as a prescription as

well.

I second Alice's suggestion. I would have gotten a case manager long ago if

I had known how much easier it has made my life.

laurie

>

> Reply-To:

> Date: Sat, 10 Jul 2004 11:17:36 -0600

> To: >

> Subject: Re: : insurance woes - Case Managers

>

> I can't stress enough the need for each member of this list to get a case

> manager. The case manager works for you with the insurance companies. If you

> don't have one - make it your first priority on Monday. You won't believe the

> difference this can make.

>

> Carnitor should be covered by you insurance as long as it's written in

> prescription form. I can understand the problem with CoQ as there just aren't

> many who can get this covered but Carnitor should not be denied.

>

> Alice

> Re: : insurance woes

>

>

> ,

> What reason do they give for denying the carnitor? I can't

> understand it.

>

> Another option may be find out if the drug company will provide you

> with a discount on the drugs, directly. I was told by a lady that

> worked in a doctor's office (her job was to help patients get free

> medication from the drug companies) - that if you don't have a

> prescription plan, you may qualify for free medication. You need to

> ask the nurses (not the doctors) about the patient assistant

> program, as often the doctors don't know anything about it.

>

> I'm also very frustrated with insurance companies. I am insured

> with Fortis, which is one of the larger companies that handles a lot

> of people who are self employed. I am amazed at how the insurance

> companies are so blatantly sticking it to us these days. They raise

> our premiums (I just got another BIG increase this week) until we

> can no longer afford it -- and at the same time, they create

> different products (policies) which are more affordable and only

> offer them to their " healthy " policyholders.

>

> Eventually everyone with a health issue will be forced to drop their

> insurance because of lack of affordability (a great way for the

> insurance companies to keep their costs down -- by weeding out the

> sick).

>

> It shouldn't be legal. I was told by my agent that the only real

> option I have is to go to state insurance (HMO) where they have to

> accept me. Unfortunately, it severely limits my choice of doctors

> that I can see (hard enough to find a doctor on a large PPO plan,

> I'm not sure how you that have to - are finding the right doctors on

> restricted HMOs).

>

> Maggie

>

>

>

>> well looks as if I wont be getting any relief anytime soon.

>> My insurance wont cover carnitor and I cant afford COQ10.

>> the insurance also refuses to cover my kids pancreatic enzymes. I

> have

>> appealed and so has the docs, still getting denials. frustrating.

> you would think

>> they would rather cover the drugs then the doc visits it might

> save.

>>

>>

>

>

>

[Guest guest]

Hi Alice,

Does the case managers work for the insurance companies because I don't think

the one we have is much of a help. When we had our HMO the case manager really

went to bat for us a few times she was wonderful. Can I ask for a new one and

how would I go about it thanks.

Donna

>

>

> Date: 2004/07/10 Sat PM 01:17:36 EDT

> To: >

> Subject: Re: : insurance woes - Case Managers

>

> I can't stress enough the need for each member of this list to get a case

manager. The case manager works for you with the insurance companies. If you

don't have one - make it your first priority on Monday. You won't believe the

difference this can make.

>

> Carnitor should be covered by you insurance as long as it's written in

prescription form. I can understand the problem with CoQ as there just aren't

many who can get this covered but Carnitor should not be denied.

>

> Alice

> Re: : insurance woes

>

>

> ,

> What reason do they give for denying the carnitor? I can't

> understand it.

>

> Another option may be find out if the drug company will provide you

> with a discount on the drugs, directly. I was told by a lady that

> worked in a doctor's office (her job was to help patients get free

> medication from the drug companies) - that if you don't have a

> prescription plan, you may qualify for free medication. You need to

> ask the nurses (not the doctors) about the patient assistant

> program, as often the doctors don't know anything about it.

>

> I'm also very frustrated with insurance companies. I am insured

> with Fortis, which is one of the larger companies that handles a lot

> of people who are self employed. I am amazed at how the insurance

> companies are so blatantly sticking it to us these days. They raise

> our premiums (I just got another BIG increase this week) until we

> can no longer afford it -- and at the same time, they create

> different products (policies) which are more affordable and only

> offer them to their " healthy " policyholders.

>

> Eventually everyone with a health issue will be forced to drop their

> insurance because of lack of affordability (a great way for the

> insurance companies to keep their costs down -- by weeding out the

> sick).

>

> It shouldn't be legal. I was told by my agent that the only real

> option I have is to go to state insurance (HMO) where they have to

> accept me. Unfortunately, it severely limits my choice of doctors

> that I can see (hard enough to find a doctor on a large PPO plan,

> I'm not sure how you that have to - are finding the right doctors on

> restricted HMOs).

>

> Maggie

>

>

>

> > well looks as if I wont be getting any relief anytime soon.

> > My insurance wont cover carnitor and I cant afford COQ10.

> > the insurance also refuses to cover my kids pancreatic enzymes. I

> have

> > appealed and so has the docs, still getting denials. frustrating.

> you would think

> > they would rather cover the drugs then the doc visits it might

> save.

> >

> >

>

>

>

[Guest guest]

Donna

I think that there are different ways that an insurance company can do case

management. My case manager works for a case management and is paid at an

hourly (I believe) rate by the insurance company. She has taken over so much

of the phoning, etc. As she said, " I am a nurse and I have a company behind

me so I have more glout. " She not only deals with the insurance company, but

also providers.

You might want to call your insurance and ask how they provide case

management. What I found out was the more expensive things I needed, the

more they encouraged me to have a case manager. I am sure there are always

good and bad.

laurie

>

> Reply-To:

> Date: Sat, 10 Jul 2004 18:06:04 -0400

> To: >

> Subject: Re: Re: : insurance woes - Case Managers

>

> Hi Alice,

> Does the case managers work for the insurance companies because I don't think

> the one we have is much of a help. When we had our HMO the case manager really

> went to bat for us a few times she was wonderful. Can I ask for a new one and

> how would I go about it thanks.

> Donna

>>

>>

>> Date: 2004/07/10 Sat PM 01:17:36 EDT

>> To: >

>> Subject: Re: : insurance woes - Case Managers

>>

>> I can't stress enough the need for each member of this list to get a case

>> manager. The case manager works for you with the insurance companies. If

>> you don't have one - make it your first priority on Monday. You won't

>> believe the difference this can make.

>>

>> Carnitor should be covered by you insurance as long as it's written in

>> prescription form. I can understand the problem with CoQ as there just

>> aren't many who can get this covered but Carnitor should not be denied.

>>

>> Alice

>> Re: : insurance woes

>>

>>

>> ,

>> What reason do they give for denying the carnitor? I can't

>> understand it.

>>

>> Another option may be find out if the drug company will provide you

>> with a discount on the drugs, directly. I was told by a lady that

>> worked in a doctor's office (her job was to help patients get free

>> medication from the drug companies) - that if you don't have a

>> prescription plan, you may qualify for free medication. You need to

>> ask the nurses (not the doctors) about the patient assistant

>> program, as often the doctors don't know anything about it.

>>

>> I'm also very frustrated with insurance companies. I am insured

>> with Fortis, which is one of the larger companies that handles a lot

>> of people who are self employed. I am amazed at how the insurance

>> companies are so blatantly sticking it to us these days. They raise

>> our premiums (I just got another BIG increase this week) until we

>> can no longer afford it -- and at the same time, they create

>> different products (policies) which are more affordable and only

>> offer them to their " healthy " policyholders.

>>

>> Eventually everyone with a health issue will be forced to drop their

>> insurance because of lack of affordability (a great way for the

>> insurance companies to keep their costs down -- by weeding out the

>> sick).

>>

>> It shouldn't be legal. I was told by my agent that the only real

>> option I have is to go to state insurance (HMO) where they have to

>> accept me. Unfortunately, it severely limits my choice of doctors

>> that I can see (hard enough to find a doctor on a large PPO plan,

>> I'm not sure how you that have to - are finding the right doctors on

>> restricted HMOs).

>>

>> Maggie

>>

>>

>>

>>> well looks as if I wont be getting any relief anytime soon.

>>> My insurance wont cover carnitor and I cant afford COQ10.

>>> the insurance also refuses to cover my kids pancreatic enzymes. I

>> have

>>> appealed and so has the docs, still getting denials. frustrating.

>> you would think

>>> they would rather cover the drugs then the doc visits it might

>> save.

>>>

>>>

>>

>>

>>