Guest guest Posted October 25, 1998 Report Share Posted October 25, 1998 The ordeal of the day-i called in a refill for one of AJ's scripts. She has been on Prilosec for a year-at least. Now the insurance company is saying that it is only prescribed for kids over 5 and they won't pay for it. It is a prescription med, not an over the counter. She has had it refilled 10-12 times already with the same insurance company. Ridiculous or what? The pharmacist gave me the name and number to call but i have to do it tomorrow-a work day. Just when i finally get the Neocate covered-this happens. I know it is not major, just another hassle to deal with. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 25, 1998 Report Share Posted October 25, 1998 Phyllis, Do you have a GI case manager for AJ's insurance needs. I can tell you that it makes a world of difference. I have Keystone Health Plan East. They gave me so many problems last year with insurance coverages. At one point I was spending over 20 hours a week on the phone with the docs, hospital and insurance trying to get things covered. Once I got a case manager everything changed. Good Luck Jen ( 11/7/95, eosinophilic esophagitis, food allergies, asthma) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 1998 Report Share Posted October 26, 1998 In a message dated 10/26/98 7:40:41 AM Eastern Standard Time, Jenericm@... writes: << Once I got a case manager everything changed. >> Jen: I agree. We had the same problem with Clayton until we got a case manager - We have AmeriHealth PPO. I just called Clayton's case manager and did not even have to give her an ID number as she knew who we were - this helps. I called to ask for nursing care for 2 hours a day from Thursday Night November 19 - Monday morning November 23. We need an hour in the evening to hook him up to his feeding pump and ensure that it is working and another hour in the morning to unhook him and give him his meds (probably only 1/2 hour in the AM). Barry and I are supposed to be going to Las Vegas for a long weekend with about 10 other people. I have someone to watch the twins (my mom is taking Jake to Florida) but I do not feel comfortable with her hooking Clayton up. She knows how to use the machine if the error light blinks but I do not think that she should be giving him his meds and hooking him up. The case manager was already going to get approval from the medical director and my pediatrician is writing a letter saying that we need this. She did not think approval would be difficult. Love, Sharon mommy to Jake (5) and fraternal twins (34.5 weeks) (3/30/97) - Cole -(nda) and Clayton (eosinophilic gastroenteritis, food allergies (milk, soy, eggs, wheat), g-tube, Nissen and possible latex allergy, some DD, undiagnosed neuro issues and sensory integration disorder) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 1998 Report Share Posted October 26, 1998 In a message dated 10/26/98 8:25:31 PM Eastern Standard Time, remiaj@... writes: << s you know, we also have Amerihealth PPO. I didn't know you could get a case manager. I will have to look into this. Thanks. PS. If you went to school with Debbie Levin do you know Gayle Young, now Gayle Silverman. I thought she graduated with debbie. >> I did not ask for a case manager but Clayton had one originally (actually both the twins did due to apnea monitors and the like). Once off the monitors then no case manager. When Clayton started to seriously go downhill (before the Nissen and g-tube) and the medical bills and such started to pile up and I threatened to sue them over their failure to pay for the formula a case manager was appointed. She works with us to get things covered. No, I do not know Gayle Silverman. Debbie is a year younger than me - different circle of friends - but she still lives in Cherry Hill. Love, Sharon mommy to Jake (5) and fraternal twins (34.5 weeks) (3/30/97) - Cole -(nda) and Clayton (eosinophilic gastroenteritis, food allergies (milk, soy, eggs, wheat), g-tube, Nissen and possible latex allergy, some DD, undiagnosed neuro issues and sensory integration disorder) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 1998 Report Share Posted October 26, 1998 Sharon- As you know, we also have Amerihealth PPO. I didn't know you could get a case manager. I will have to look into this. Thanks. PS. If you went to school with Debbie Levin do you know Gayle Young, now Gayle Silverman. I thought she graduated with debbie. Jen- I will also look into, who in the GI office helped us with getting the Neocate covered. If it is not a case manager, she stills knows how to get things moving. I will try there too. Phyllis Quote Link to comment Share on other sites More sharing options...
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