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Yenni

Angry Dealing W. Insurance Company About Medication

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I am so mad at our insurance company (the pharmaceutical part-Caremark). I have been eating Protonix twice daily for 4 years now and there hasn't been a generic for it. So I generic just came out and our insurance company will not pay for brand if there is a generic. The generic has dairy in it and I can't do casein. I was given a birth control pill last spring with this same dairy substance in it and it made me ill. So now we have been in this rut talking to the doctors office, the national insurance company and the local people for almost a month. I have been out of Protonix that long. I have borrowed from my father in law and been given a few samples from the doctors office.

The doctor needs to, every time I get a prescription of every kind that has a generic with anything I can't have, write a letter to the insurance company and fax it in. Then it will take up to a month (!!!) for it to go through/get approved. What if I need antibiotics right away???? This is absolutely crazy!!

We have found a nice man at the local place that can get the process done much faster, but I still think it will be a couple of days for him to get it approved, so there is the issue again: what is it is urgent???

This is so stupid.

End vent/rant.

Anyone else have had any similar problems?


One Celiac gene and one gluten intolerance gene (HLA-DQ 2,1).

Grain free, casein free, soy/legume free + a bunch of allergies I have had since I was a child (stone fruits, nuts..carrots)

Following the Specific Carbohydrate Diet, but no nuts, legumes or casein.

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How frustrating! It is quite obvious that insurance companies couldn't care less about people's health, it is all about money. I've had tons of problems with my insurance company as well, when they didn't want to pay for necessary dental work (my dentist had to fight with them a few times, so frustrating).

I hope they see the light soon.


I am a German citizen, married to a Canadian 29 years, four daughters, one son, seven granddaughters and four grandsons, with one more grandchild on the way in July 2009.

Intolerant to all lectins (including gluten), nightshades (potatoes, tomatoes, peppers, eggplant) and salicylates.

Asperger Syndrome, Tourette Syndrome, Addison's disease (adrenal insufficiency), hypothyroidism, fatigue syndrome, asthma

------------------------------------------------------------------------------------------------------------------

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How frustrating! It is quite obvious that insurance companies couldn't care less about people's health, it is all about money. I've had tons of problems with my insurance company as well, when they didn't want to pay for necessary dental work (my dentist had to fight with them a few times, so frustrating).

I hope they see the light soon.

Yes, they sure do not seem to care about the person, all about the money.

I am so frustrated about it. My doctors office has called and faxed a letter, but nothing yet.

Crazy and maddening. Is it going to be this hard every time?


One Celiac gene and one gluten intolerance gene (HLA-DQ 2,1).

Grain free, casein free, soy/legume free + a bunch of allergies I have had since I was a child (stone fruits, nuts..carrots)

Following the Specific Carbohydrate Diet, but no nuts, legumes or casein.

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I am so mad at our insurance company (the pharmaceutical part-Caremark). I have been eating Protonix twice daily for 4 years now and there hasn't been a generic for it. So I generic just came out and our insurance company will not pay for brand if there is a generic. The generic has dairy in it and I can't do casein. I was given a birth control pill last spring with this same dairy substance in it and it made me ill. So now we have been in this rut talking to the doctors office, the national insurance company and the local people for almost a month. I have been out of Protonix that long. I have borrowed from my father in law and been given a few samples from the doctors office.

The doctor needs to, every time I get a prescription of every kind that has a generic with anything I can't have, write a letter to the insurance company and fax it in. Then it will take up to a month (!!!) for it to go through/get approved. What if I need antibiotics right away???? This is absolutely crazy!!

We have found a nice man at the local place that can get the process done much faster, but I still think it will be a couple of days for him to get it approved, so there is the issue again: what is it is urgent???

This is so stupid.

End vent/rant.

Anyone else have had any similar problems?

YES! Absolutely & with CAREMARK

Doctor must write this code on the original prescription: DAW

The doctor must indicate that for health reasons you cannot have the generic. This has worked us me with Caremark. It should not take a month (however, it did take almost that long the first time I had to do this because Caremark was extremely indifferent about it - this was in 2004). I was on phone with them about a month ago and the Rep. seemed to know exactly what I was talking about and why a brand name was needed. Keep at them, call them and ask about the code DAW.

Keep in mind that you will have to pay a higher co pay or a higher cost than the generic. There's no way around that one.


Husband has Celiac Disease and

Husband misdiagnosed for 27 yrs -

The misdiagnosis was: IBS or colitis

Mis-diagnosed from 1977 to 2003 by various gastros including one of the largest,

most prestigious medical groups in northern NJ which constantly advertises themselves as

being the "best." This GI told him it was "all in his head."

Serious Depressive state ensued

Finally Diagnosed with celiac disease in 2003

Other food sensitivities: almost all fruits, vegetables, spices, eggs, nuts, yeast, fried foods, roughage, soy.

Needs to gain back at least 25 lbs. of the 40 lbs pounds he lost - lost a great amout of body fat and muscle

Developed neuropathy in 2005

Now has lymphadema 2006It is my opinion that his subsequent disorders could have been avoided had he been diagnosed sooner by any of the dozen or so doctors he saw between 1977 to 2003

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YES! Absolutely & with CAREMARK

Doctor must write this code on the original prescription: DAW

The doctor must indicate that for health reasons you cannot have the generic. This has worked us me with Caremark. It should not take a month (however, it did take almost that long the first time I had to do this because Caremark was extremely indifferent about it - this was in 2004). I was on phone with them about a month ago and the Rep. seemed to know exactly what I was talking about and why a brand name was needed. Keep at them, call them and ask about the code DAW.

Keep in mind that you will have to pay a higher co pay or a higher cost than the generic. There's no way around that one.

Than you!! Good information.

Yes, it will be a bit higher price but much better than paying $150 every month (or more).

I will print this out. Thanks again!

So if you need antibiotics for example, do you ask the doctor to write the code AND write a letter every time or?


One Celiac gene and one gluten intolerance gene (HLA-DQ 2,1).

Grain free, casein free, soy/legume free + a bunch of allergies I have had since I was a child (stone fruits, nuts..carrots)

Following the Specific Carbohydrate Diet, but no nuts, legumes or casein.

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Than you!! Good information.

Yes, it will be a bit higher price but much better than paying $150 every month (or more).

I will print this out. Thanks again!

So if you need antibiotics for example, do you ask the doctor to write the code AND write a letter every time or?

Yes if only the brand name is gluten free.


Husband has Celiac Disease and

Husband misdiagnosed for 27 yrs -

The misdiagnosis was: IBS or colitis

Mis-diagnosed from 1977 to 2003 by various gastros including one of the largest,

most prestigious medical groups in northern NJ which constantly advertises themselves as

being the "best." This GI told him it was "all in his head."

Serious Depressive state ensued

Finally Diagnosed with celiac disease in 2003

Other food sensitivities: almost all fruits, vegetables, spices, eggs, nuts, yeast, fried foods, roughage, soy.

Needs to gain back at least 25 lbs. of the 40 lbs pounds he lost - lost a great amout of body fat and muscle

Developed neuropathy in 2005

Now has lymphadema 2006It is my opinion that his subsequent disorders could have been avoided had he been diagnosed sooner by any of the dozen or so doctors he saw between 1977 to 2003

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Join eNewsletter

I've been going through the same thing. It is so frustrating. I too have been without a medication for about 3 weeks now due to the fact that I have to get my Dr. to write a letter to my ins. company explaining why I have to have name brand when generic is available. It's ridiculous. :blink:


Jennifer

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