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        New Message Board Archives >> 2002 Posts >> Reimbursement denial
        
(Message started by: cootie on Nov 25^th, 2002, 5:31pm)

Title: Reimbursement denial
Post by cootie on Nov 25^th, 2002, 5:31pm

Our insurence just sent us a note that they have denied our request for rembursement for a script of imitrex we paid for cash "inbetween" the red tape of our doc gettin thru ta them we needed more then 9 pills a month...we HAD to get them and HAD to pay ourselves cuz the cycle was beginnin....was told to send them receipts ect for reimbursement. So.....is it a lost cause to continue to hassle with this matter I wonder ?? The script ran just under $200.00....we did get them to ok more with doc haveing to call there hotline 'each time' and explain for approval....that was a small victory tho for us.....I'm worried someday they will refuse all together on down the line ??? What is it made out of to be such a problem to get...... :-/

Title: Re: Reimbursement denial
Post by Not4Hire on Nov 25^th, 2002, 5:56pm

.....ca$h money.....only language they speak.......PAIN has no "$" in it......ya think?

....small victories, but better than some have...... ;)

Title: Re: Reimbursement denial
Post by cootie on Nov 25^th, 2002, 6:07pm

....I guess we get to thinkin it is us against them (insurence co's) to much....he pays in so much a month it is crazy for them to do this denial thing....but then again there are people more worse off that can't afford treatments peroid and get no insurence help. I jus don't know if I should pursue it or let it go and risk them maybe turning on us next round if I question too much.....what a racket.......

Title: Re: Reimbursement denial
Post by cerebus on Nov 25^th, 2002, 6:26pm

My advice?

read over your reimbursement clause to make sure you followed the directions explicitly and if you made no errors, have your attorney call em. ::)
Cerebus

Title: Re: Reimbursement denial
Post by cootie on Nov 25^th, 2002, 7:20pm

Thanx for the advice....what I did was call the insurence sales repp for the shop and follow'd her directions when this situation came up...not sure she knows what the insurence co will really do tho....she doesnt' seem positive enuff and basically says 'try this' !! Bradley said he is gonna take the denial into the office and go from there....I knew he'd be ticked when he found out....dunno if we have a leg to stand but got a feeling I better find out for the next cycle.....nice to be a lill informed tho....I appreciate it the advice.....thanks

Title: Re: Reimbursement denial
Post by don on Nov 26^th, 2002, 6:22am

What you need to do is contact Glaxo Smith Klien

http://www.gsk.com/index.htm

Tell them the situation and ask that a case Manager be assigned to you.

Title: Re: Reimbursement denial
Post by cootie on Nov 26^th, 2002, 9:40am

Thanx don...will check into that....I jus need to be prepared to go thru this 'next' more knowledgeable and wanna handle it rite....there sayin the meds were NOT approved to be paid at the time we paid for the script ourselves we HAD to have...was goin thru the red tape gettin doc to call them and he was out of town when I found that out. So not sure what our rights on on this one.....thanks again !! It's one thing after the other with these ins. co's...ya pay in alot but gotta fight for them to pay fer stuff.........arghhhhhhhhh.......

Title: Re: Reimbursement denial
Post by rain on Nov 26^th, 2002, 1:08pm

would you believe the pharmacist told me no more this month whatsoever ...she said people are getting addicted to imitrex ???
Addicted?? I never heard of such a thing.
time for a new pharmacist !!
Ohhh by the way we only had 6 shots this month (not like we are getting tons of the stuff)
Cootie. like most people they wont give me more, and you and I know it is the insurance co. they just don't like paying the hefty price.
good luck !!

Title: Re: Reimbursement denial
Post by cootie on Nov 26^th, 2002, 2:17pm

rain.......last script I picked up for Bradley of imitrex they didn't even have enuff and had to mail us the balance.......either they jus don't keep many 'round or they are that much in demand ??? Guess we need ta check into alternatives that people suggest mite work jus in case we do get cut off next 'go round'....I have some stashed 'like it's gold' rite now.....so far he has been PF for a while but has been feelin some shadows from time to time...so it's 'still there lurking'....too bad there isn't a generic imitrex....dam that stuff is expensive !!!!!!!! Happy Gobble day to everyone............

Title: Re: Reimbursement denial
Post by Dave_W on Nov 26^th, 2002, 3:08pm

Say, when the pharmacists start rationing imitrex because they think we're using too much (and can't cite any other reason), it's time to do something! >:(
>:(

My plan only pays for 6 doses per month, but the Blue Cross guy and the doctor and the pharmacy I use say I can purchase as many more as I need. So I'm out some bucks during a cycle, and maybe my credit card balance is higher than it needs to be but if somebody told me I couldn't have 'em I might be in jail for busting them in the nose a good one, yessir.

Old Dave

Title: Re: Reimbursement denial
Post by cootie on Nov 26^th, 2002, 3:39pm

.....that's what scares me is how we could get denied imitrex for what ever reason.....it's one thing we may have ta pay fer it ourselves outa our pocket and go in debt but it's anuther thing if we CAN'T get it. Lotta people'd be in jail I think !!! It was a real PANIC situation this cycle when insurence gave us some shit.....this rembursement ordeal is jus anuther snag in the net. Boy think how much money a person could make on that stuff if ya could gather a shitload from Mexico and sell it on eBay.......yeah rite......from jail !!!!! (jus jokein) I'm gettin worried bout this situation tho myself........

Title: Re: Reimbursement denial
Post by rain on Nov 27^th, 2002, 1:51am

I'm just gathering all the imitrex I can so when "it" comes back hopefully we will be ready and have enough.
Right now the CH seems to be sleeping just poking it's ugly head up for little visits...

I wrote an e-mail to glaxco-welcome about the price...I mean really dont you think that by now they have made there money back from all the research??? They must be making a mint ..off our pain..makes me angry !!

Well they worte me back and simply said..sorry ..Ohhh here is a coupon...*L*
Ohhh yeay thats really going to help *please!!
anyway the pharmacist said that they hold the patent on imitrex another 2-3 years...until then they can charge what they want .
I pray for the day it becomes cheaper ..
Take care ...Rain

Title: Re: Reimbursement denial
Post by cootie on Nov 27^th, 2002, 9:24am

I'll jus bet after that 3 year patent is up things will change drastically price wise.....I've dealt with alot of generic drug prices verses the brand name and on some stuff the reg. price would be as high as $ 75.00 or higher and generic would be $ 8.00.....now 'that's a drastic price difference ! Also....update about the rembursement.....get this......shops inusurence co. sent them a letter (he jus told me last nite) that they are uppin the premium $ 2,500.......so the shop is droppin em and switchin co's "agin" !!! Oh noooooo !! Small shop of only bout 8-9 guys so they don't get the breaks a big shop gets. But now we gott ago thru the information papers and drug info and health info questions and last doc appt records ect ect ect....wonder how this new one will think about 'pre-existing' conditions and the meds ??? Guess it's not over till the "FAT LADY SINGS" ech ?? Insurence co's have way to much power......it's not fair......thanx all....