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Angry Dealing W. Insurance Company About Medication

Yenni

By Yenni
in Coping with Celiac Disease

Recommended Posts

Yenni Enthusiast
Yenni
Posted

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?

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Ursa Major Collaborator
Ursa Major
Posted

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.

Yenni Enthusiast
Yenni
Posted
  • Author
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?

debmidge Rising Star
debmidge
Posted
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.

Yenni Enthusiast
Yenni
Posted
  • Author
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?

debmidge Rising Star
debmidge
Posted
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.

Morrisun Newbie
Morrisun
Posted

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:

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