So we get them home from the consult, discuss options and choices, and head to the pharmacy to fill prescriptions.
One of the prescriptions she received was for Previcid, to protect her stomach from the damage it is taking from the prednisone. (she has been having a lot of stomach upset and complaining frequently of stomach pain)
The insurance denied the prescription and recommended another drug that they want her to take first - That, or we can pay the entire cost of the drug ourselves (over $100/mo).
The pharmacy has put a call in to the Dr's office to see if the alternate drug is an appropriate substitution, but that left us over the weekend without being able to start her on the medication. So the pharmacy offered to fill us through the weekend, which we did, 3 pills for $16.
I am greatful we have insurance, but this is the first time that we have been denied course of treatment as prescribed by a Dr. I'm fine with the insurance offering a lower cost to us if we use a generic drug over a brand name, but when they try to change the Drs prescription without information it is really frustrating.
I really hope I don't have to get good at appealing denied claims to insurance. I have been told never take no for an answer from insurance, but it means filing appeals and submitting claims again. I guess I will get busy educating myself on the process though, just in case.
2 comments:
Oh how I smile and sympathize with you on this. Our insurance company, like most I supposed, has changed pharmacy providers several times over the last couple of years. Every time they do we have to switch from one company's "preferred" drug, to the new company's "preferred" drug. It doesn't affect most of my medications because they are generic, but the prevasid/prilosec one ALWAYS has to be switched. I finally just chose the over-the-counter one and buy it at Sam's.
Got that cleared up. Dr changed orders for the med to the 'preferred' med. She doesn't like the new stuff as well because the capsels get stuck in her throat, but she can get them down, so we are doing good. I'll have to try getting her to drink more water before taking the pill. If it gets too bothersome we will open them up and dump them in applesauce for her.
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