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[questionseverything]

697. maybe this exchange will help you understand

the language was there.....


are you saying the ins paid for meds not covered in contract?





now if you were arguing over what is "reasonable and customary" then yes there is contract language that state ins department could help with

but if you are saying you got something covered that was not in contract......I call bs

without knowing what will has in his contract's language, it is impossible to tell

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Response to questionseverything (Reply #263)

Tue Mar 18, 2014, 09:20 PM

Star Member Nye Bevan (14,816 posts)

273. My policies (and I believe most policies) have "non-formulary exception" provisions





with this kind of language:



Non-formulary exception process

The non-formulary exception process provides physicians and members with access to non-formulary drugs and facilitates prescription drug coverage of medically necessary, non-formulary drugs as determined by the prescribing practitioner.
Patients can also have a non-formulary drug without invoking the exception process anytime by paying full price for the drug if the prescribing provider deems the non-formulary drug not medically necessary, but agrees to prescribe the drug due to patient demand.
The prescribing practitioner makes the final decision regarding what drug is appropriate for the member. Non-formulary drugs should be used only if the patient fails to respond to formulary drug therapy, has an adverse reaction to formulary drug, or has other special circumstances requiring the use of a non-formulary drug.
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I would like to address this quote of yours..

Because blasting it gives ammunition to those who want to destroy it and replace it with nothing. //////////////////////

pointing out problems is the only way to fix them.....I have never seen any1 on du say they wanted to repeal aca only that we want it expanded and costs lowered