I know. I know. I've already written a bunch of posts complaining about health insurance companies. Here's another one to add to the list.
Effective January 1, our insurance company put a supply limit on one of Marty's maintenance medications. The limit-- 13 tablets per 365 days. Now, as I mentioned, this is a maintenance medication--he takes 2 pills a day. According to a letter they sent us "the supply limits apply to lower strengths that are typically only used at the beginning of a therapy to allow adjustment time before your doctor increases the dosage strength of your medication." Marty has basically been on this dosage for 4 years. I wouldn't call that just the beginning of his therapy.
The work-around for this supply limit is that Marty's doctor needs to call the insurance company, answer a bunch of questions and jump through their "prior authorization" hoops.
Marty's doctor has done this TWICE. And TWICE they have told him that no prior authorization was needed. Yet they still won't cover the stupid refill at the pharmacy because the doctor hasn't done the prior authorization.
Fortunately, the pharmacy has been somewhat understanding--First they gave him a few pills to carry him over. Then they filled the prescription and only charged us the co-pay, assuming the insurance company would eventually get their act together.
So far they haven't.
3 comments:
Few things disgust me more than the insurance system these days. I think. There might be worse offenders out there, but I sure can't think of them now.
I'm sorry. The best I can say is, gather all the info from previous calls: when you called, who you spoke with, what you were told as well as when the doctor called and who they spoke with and what they were told. Then call the insurance with all of that information. If the person you are speaking with can't or won't fix it, speak to the supervisor...and keep going until they resolve it. That is SO frustrating.
I keep thinking there's a joke here involving you yelling the phrase "preauthorize this" while performing some obscene gesture. Or maybe something like "Your momma didn't need any pre-authorization." But I just can't seem to get the joke together, and both directions seem somewhat inappropriate for a comment on a blog that YOUR momma (and mine) reads.
So, instead, I'll just leave this angry emoticon for solidarity. ;{
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