General Discussion
In reply to the discussion: So let me see if I've got this straight... [View all]ChiciB1
(15,435 posts)to be very well informed on OH so many things. I saw Will P's post yesterday and then again today. Been taking soooooo much of my time reading ALL the 100's of comments, but I myself have been denied medication coverage. BUT I don't have insurance through ACA. I have a Medicare Retiree Replacement PPO, from Humana. My Dr. already stated it was medically necessary, AND he filled out forms & sent them to Ins. They still denied & sent me paperwork to APPEAL within 60 days. This is a medication he's prescribed for me on a monthly basis, but all of a sudden they say no. I suppose it's age related, but saw him again and had already checked with local pharmacy for a price. It was $10.00 so I had it filled & told them NOT to use my insurance. However, when I picked up the script I was informed I could appeal again and pay only $6.77. Not worth it to me at this time.
I suspect I'm going to get another medication I take monthly denied because it's not on my formulary and it's seriously infuriating having to go through this process. Are you saying I should contact my state Insurance Comm. about these denials even when my Dr. tells the insurance company it's medically needed and they still deny?
I'm sure I KNOW why I'm getting denials. but why should "we the people" have to submit appeals time & time again? I live in Florida, my Representative is Vern Buchanan (big R) and state legislation is Repuke controlled, AND my Governor is Rick Scott! Whatta ya think?? Order from Canada??
BTW, I have friends who have gone the Canada route and at a much cheaper price. I thought it was illegal but don't know for sure.
Sorry this is so long, but your suggestion sounds valid, but wondering if it will do much considering where I live. I see this happening over and over with my friends AND want to say that it isn't something specific to ACA.
THIS IS AN ISSUE where insurance seems to be controlling what THEY think is good for you. I DO NOT understand why, if a medication you've been taking for a long time and has NEVER caused ANY adverse outcomes that they can now say they won't cover it!
And to Will Pitt, I'm so sorry for what you're going through... but as I pointed out, I haven't changed my insurance because it has good coverage through my husband's Union job, from which he's now retired. I wonder if it's not something cooked up between Ins. & Big Pharma. I DON'T understand this myself!!