Battling with the insurance company [View all]

[ejpoeta]

My daughter has ADHD. Through her primary care physician we have had her on a bunch of different prescriptions to address her ADHD. First, of course, was ritalin LA. That worked well, but had to be changed to the regular ritalin that had to be administered 2x a day due to us having to pay for it ourselves.. didn't work as well. So back to the LA. Then I was getting calls about picking issues. Hygiene problems. So lets switch. Welbutrin. Did nothing. So another couple that if they worked did not help the picking issue. Then I decided perhaps to change tacts and take Emily to a doctor at where Emily gets counseling. I finally got her in for an appointment and they suggested a medicine. It is a controlled substance like the ritalin was, and I took it right to the pharmacy. Well, I didn't get preauthorization, so they couldn't fill it right away. Then the troubles began.

I guess this medicine costs almost $300/mo. And there isn't a generic. Well, the fully qualified doctors at the insurance company decided Emily should try ritalin first. Well, I guess they didn't know that she already tried that. My husband has been battling with them for a week to get them to fill this prescription. And it got pretty heated. And at one point they refused to talk to him about it (after they already had been doing so) because he was not the main person on the account. That is hilarious since it was in his name. But I digress.

It got pretty heated, for sure and bob was yelling... a lot. He was calling more than once a day. They sent us a denial letter. He tried to go through the doctor's office. We made sure they had a list of all the meds Emily had already taken. They FINALLY decided to cover it yesterday. Bob went to the pharmacy and was told the insurance company said to wait until Thursday to fill it. He got right on the phone and went another round and came home with a filled subscription.

We shouldn't have to fight with the insurance company. The truth is that they just didn't want to have to pay for it. And now, when my daughter goes in to be monitored to see if it will work, we won't be able to determine whether she is being benefited by taking this medication. It might not, but now we will have to go another month before we can tell, and they will be paying for another month of it. It is just very frustrating. And not right.