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I HATE insurance companies

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Post  Paradox Fri Dec 11, 2009 6:08 pm

On Nov. 24 I was prescribed 30 vicoprofen for back pain, I was to take 1-2 tablets as needed 3x a day. So if I had taken it as prescribed that would have 6 tablets a day. The 30, at that rate would have lasted me 5 days, or until Nov.29th.

Today, Dec. 11, the Dr. called a refill in for me. So the 30 at six a day averaged to me taking 1.8 pills a day (it was actually fewer than that since I still have five).

When I went to pick them up the pharmacy said they couldn't fill it because the insurance company said it was "too soon". I have to wait until Dec. 13th to pick them up.

What gives????? ARRRGGGGHHHH

I'm just thankful I have some left since it's been a bad pain day.

Charlotte
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Post  LG Fri Dec 11, 2009 6:29 pm

what? too soon?

what the hell is that? it makes no sense!
Really, it doesn't. If you take as prescribed, you would have used them
up way sooner than now. They should be thanking you, not denying you.
Stupid. Evil or Very Mad
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Post  AuntieBubbs Fri Dec 11, 2009 11:53 pm

Yeah but insurance companies don't cover based on what your dr. prescribes, they cover based on what they think a dr. should prescribe. They arrive at that determination based on an amount they determine that the average patient would need, which is how they arrived at a generic "30 per month" type number. Your dr. can prescribe more, ie., 2 per day, but the insurance may not cover that. They'll tell you its your job to check with them on if they cover 2 a day or 6 a day or just 1.

I know, it sucks. And it doesn't hold true for all medication (I never encountered a limit on the amount of Topomax I took, but I'm sure there was one, I just never hit it, I guess). I don't agree with it, but that's what I've figured out from years of dealing with insurance companies. Its why I starting hoarding medication, to be honest. The dr. prescribed a higher miligram for me, I split the medication, and tried a lower dose that way. If the lower dose worked I kept the split meds because the quantity limit the insurance company imposed was not on miligrams, just on how many pills I could get.

For example, a 1 month supply of Imitrex is 9 pills, whether they are 50 milligrams or 100. If I only need 50 milligram dosages for my migraines, but can get the 100 mgs for the same copay, I will get the 100 mgs and split the pills. Twice the amount for the same copay.

I don't know if that's exactly a good thing to advocate doing, but when you're on a budget, you do what you have to do.
(BTW, I no longer have insurance coverage, but that's a fairly new state of affairs for me. I still split my Imitrex tablets, too, but that's because I pay the OTC price and its outrageous. If I can make a half dose of imitrex work for a 4 or 5 level migraine, I will. Why waste 100 mgs if I don't need to?)

Hope that helps.
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Post  tecky Sat Dec 12, 2009 8:07 am

Oh, insurance companys.........

I just went off my former employer's insurance and onto COBRA. I received a letter in the mail the day before yesterday saying my coverage was cancelled. Scared the heck out of me!

I had also received a few letters indicating doctor and hospital bills were delayed for further information. Unusual since I had called for preauthorization and they told me these bills would be covered fully.

According to the HR Dept., they send the cancellation letter to everyone, and I AM covered by insurance. I was supposed to be receiving a new card indicating my coverage the next day (haven't received it yet). Do they have any idea what these paperwork tricks do to a migraineur? Gee whiz.......

Sorry to hijack the post to another aspect of insurance companies, but this really upset me.

Becky affraid
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Post  Olee Sat Dec 12, 2009 8:58 am

It's so true about the insurance company's idea of what the "standard prescription" should be. I've had so many medications that when taken as directed I run our before the insurance company would allow a refill. It's only when it's pain meds that it is made to look so evil and sordid. I have come right out and told my doctors when they are writing prescriptions that if they write it short, I will not be able to fill a refill when it comes due. My doctor writes out my pain meds to the max to make sure it lasts to the insurance company's limit of refill. But I feel your frustration, it sucks I believe you.
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Post  Paradox Sat Dec 12, 2009 10:21 am

I told hubby I'm tempted to tell the pharmacy that I don't have any insurance and just pay full price for it. But, I do the believe the DR's office would get suspicious if I wanted the painkillers called in to one pharmacy, and other expensive med's called in to another. Evil or Very Mad

Charlotte
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Post  Olee Sat Dec 12, 2009 10:34 am

I've done that exact same thing when I got to the window and the pharmacist informed me that it was too early to refill the prescription. I subtly explain or remind them that I took the previous prescription as directed and that the refill is needed as ordered by my doctor. Therefore I will pay full price. I think sometimes this is a better idea than using a different pharmacy, multiple pharmacies sends up red flags to most physicians and can cause suspicion.
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Post  AuntieBubbs Sat Dec 12, 2009 12:14 pm

You could try getting the insurance to preauthorize the prescription if it's something you're going to be on for a long time. Otherwise, yeah, it sucks but I can't think of anything else, except splitting a higher dose, which I mentioned earlier.

Good luck Smile
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